'दिव्या� ��ग चिकित्� �ा प्रमाण पत्र Disability Medical Certificate'.pdf

Institute/Hospital Details:
- Certificate No.: [Insert Number]
- Date: [Insert Date]

Disability Certification:
1. The undersigned certifies that [Name], son/daughter of [Father's Name], aged [Age], sex [Male/Female], suffers from a permanent disability as follows:
- Locomotor or Cerebral Palsy:
- [Specify category applicable, e.g., BL, BA, OL, OA, BH, MW]
- Blindness or Low Vision: [B, PB, D, PD - Select applicable categories]
- Hearing Impairment: [D, PD]

2. The condition is [Progressive/Non-progressive/Likely to improve/Not likely to improve]. Re-assessment after [Recommended period, e.g., 3 years] is recommended.

3. Estimated disability percentage: [Percentage]

4. Physical Requirements for Discharge of Duties:
- Can perform work by manipulating with fingers: [Yes/No]
- Can perform work by pulling and pushing: [Yes/No]
- Can perform work by lifting: [Yes/No]
- ... (Continue with all applicable requirements from (i) to (x))

Signatures:
- Doctor's Signature 1
- Doctor's Signature 2
- Doctor's Signature 3

Medical Board Members:
- Name: [Member 1, Registration No.]
- Name: [Member 2, Registration No.]
- Name: [Chairperson/Member, Registration No.]

Counter Signature:
- Medical Superintendent/CMO/Head of Hospital (with seal)

Notes:
- This certificate complies with the Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Rules, 1996.
- For temporary disabilities, the certificate is valid for 5 years; for permanent disabilities, it is valid indefinitely.
- A recent color photograph showing the disability (attested by the Medical Board Chairperson) must be attached.