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General Medical Certificate 2018

This document contains a general medical certificate for a patient seeking to study abroad as a medical student. It summarizes the patient's personal information, date of birth, and confirms they are free from infectious diseases and in good physical and mental health. It also lists the results of several medical tests, including for HIV, Hepatitis B and C, and a chest x-ray, and confirms there are no medical objections to studying abroad. The certificate is signed and dated by the certifying doctor.

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sheryarbismal
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1K views1 page

General Medical Certificate 2018

This document contains a general medical certificate for a patient seeking to study abroad as a medical student. It summarizes the patient's personal information, date of birth, and confirms they are free from infectious diseases and in good physical and mental health. It also lists the results of several medical tests, including for HIV, Hepatitis B and C, and a chest x-ray, and confirms there are no medical objections to studying abroad. The certificate is signed and dated by the certifying doctor.

Uploaded by

sheryarbismal
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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GENERAL MEDICAL CERTIFICATE

Legal name (write exactly as it appears in your passport)

First/given name:____________________________________________________________________

Family/surname:_____________________________________________________________________

Permanent home address:_____________________________________________________________

Date and place of birth (dd/mm/yyyy)___________________________________________________

The patient mentioned above is at present free from infectious diseases and is in good physical and
mental condition. There are no medical objections to a stay as a medical student abroad.

Please circle the appropriate answer below Examination date* Result


AIDS*: (HIV infection can only be detected after 3
negative / positive
months) Please attach HIV serologic test result!
Hepatitis-B*: Please attach the copy of your
vaccination card / in the lack of vaccination card attached /
card, documentation about your antibody protection level: IU/l
protection!
Hepatitis-B*: (HBV infection can only be detected after
negative / positive
3 months) Please attach HBV serologic test result.
Hepatitis-C*: (HCV infection can only be detected after
negative / positive
3 months) Please attach HCV serologic test result!
Chest X-ray: Please attach the chest’s X-ray
result (not the film!) in English/Hungarian! negative / positive
(not older than 3 months)
*Please note: tests have to be taken within a year!

Remarks:

Any chronic diseases the patient is being treated for: _______________________________________

Special needs: ______________________________________________________________________

NAME AND ADDRESS OF THE DOCTOR:

__________________________________________________________________________________

PLACE AND DATE:

__________________________________________________________________________________

SIGNATURE AND STAMP OF THE DOCTOR:

__________________________________________________________________________________

In case of any controversy the examinations may have to be repeated at the University of Pécs Medical School in Pécs, Hungary.

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