MEDICAL SURVEILLANCE PROFORMA
SL. NO : 122 DATE : 11/04/2024
NAME : SUDIP BAURI DEPARTMENT : STORE
AGE / GENDER : 23 / MALE Company : Climaveneta Climate Technologies Pvt. Ltd.
E. NO : 0 Bar Code : 957
Propose Job : STORE Location : Narsapura Industrial Area, Kolar.
PERSONAL HISTORY (H/O Alcohol /Smoking/Tobacco in any form) Alcohol - NO Tobacco - NO
PREVIOUS MEDICAL HISTORY NO
Any History of Jaundice/Typhoid/Thyroid/Any Surgeries/ Convulsions or
fits/Hospitalization/visual disturbances/Hearing problem/surgeries/skin
problem/Bleeding or pain while passing urine or stool
FAMILY HISTORY( Any history of Diabetes/ Hyper tension/Heart NA
problem / Cancer
3. Skin infection on hands, arms and face-Boils, septic fingers or NA
any other infections, Discharge from eyes, ear, nose, gums
/mouth
4. Vibration Perception Threshold Normal
GENERAL PHYSICAL EXAMINATION
HEIGHT : 170Cms WEIGHT : 66 Kg BODY MASS INDEX : 22.84
PULSE RATE : 67/min (CPT) BP : 133/78 mm/hg Ideal Weight - 70
Your BMI :Interpreting Your BODY MASS INDEX Visual Acuity
Adult Women Men
Underweight <19.1 <20.7 Distance Color Vision Near Vision Styes
In normal range
Vision
19.1-25.8 20.7-26.4
Marginally Right 6/6 Normal N-6 Normal
25.8-27.3 26.4-27.8
overweight
Overweight 27.3-32.3 27.8-31.1 Left 6/6 Normal N-6 Normal
Very overweight or >32.3 >31.1
obese
SYSTAMATIC EXAMINATION
Respiratory System: Normal
RESPIRATORY SYSTEM
Nose / Throat : Normal
On Auscultation : Normal
Hear Sound : Normal
CARDIO – VASCULAR SYSTEM Murmurs : Normal
CNR (Central nervous System): Normal
CENTRAL NERVOUS SYSTEM Peripheral System : Normal
SKIN NA
LAB INVESTIGATION
BLOOD/ Urine Non Lab /
HEMOGRAM , Lipid, KFT, RBS ECG, Audiometry,
Impression/ Fitness / Advice: Normal Study
Authorised Signature
Patient Name : SUDIP BAURI Patient ID :0
Age / Sex : 23 years / MALE Registered On : 11/04/2024, 07.20 PM
Referred by : SELF Received On : 11/04/2024, 07.20 PM
Client Name :Climaveneta Reported On : 12/04/2024, 08:21 PM
SID.No : 957
Department : BIOCHEMISTRY
Test : GLUCOSE - RANDOM* ,Fluoride Plasma,
Test Description Result Units Reference Range
GLUCOSE - RANDOM* 96 mg/dl Normal : 74 – 140
GOD-POD Prediabetes : 141 – 160
Diabetes : > =161
Comment Test repeated. Value rechecked. Kindly correlate clinically
High levels of serum glucose may be seen in case of Diabetes mellitus, in patients recieving glucose containing fluids
Test Interpretation intravenously, during severe stress and in cerebrovascular accidents. Decreased levels of glucose can be due to
insulin administration, as a result of insulinoma, inborn errors of carbohydrate metabolism or fasting.
Reference values pertains to age and sex of the patient
**END OF REPORT**
Dr.Manasa H P
Consultant Pathologist
KMC No - 92180
Page 1 of 6
Patient Name : SUDIP BAURI Patient ID :0
Age / Sex : 23 years / MALE Registered On : 11/04/2024, 07.20 PM
Referred by : SELF Received On : 11/04/2024, 07.20 PM
Client Name :Climaveneta Reported On : 12/04/2024, 08:21 PM
SID.No : 957
Department : BIOCHEMISTRY
Test : RENAL FUNCTION TEST (RFT)* ,Serum
Test Description Result Units Reference Range
BLOOD UREA NITROGEN (BUN) 19 mg/dL 8-20
UV Kinetic/Urease GLDH
*CREATININE 0.8 mg/dL 0.6 - 1.1
JAFFE/UV KINETIC
*URIC ACID 4.7 mg/dL 2.6 - 6.5
URICASE POD
*BUN / CREATININE RATIO
Calculated 24 %
*UREA/ CREATININE RATIO
Calculated 34 %
Comment Value rechecked. Kindly correlate clinically
Blood urea: Urea is produced in the liver and excreted through the kidneys in the urine. Consequently, the
circulatinglevels of urea depend upon protein intake, protein catabolism and kidney function. Elevated urea levels
can occur with dietary changes, diseases which impair kidney function, liver diseases, congestive heart failure,
diabetic and infections.
Creatinine: Creatinine is a waste product formed in muscle from the high energy storage compound,
creatinephosphate. The amount of creatinine produced is fairly constant (unlike Urea) and is primarily a function of
muscle mass. It is not greatly affected by diet, age, sex or exercise. Creatinine is removed from plasma by
glomerular filtration and then excreated in urine without any appreciable resorption by the tubules. Creatinine is a
measure of renal function and a product of metabolism of creatine.Its level is elevated in patients with derrangement
of more than 50% of renal function.
Calcium: Calcium has numerous function within the body, not only as a structural factor in bones and teeth, but also
innormal neuromuscular function and the clotting of blood.Hypercalcaemia may develop in patients with Paget’s
disease of bone and hyperparathyroidism. The cause of hypercalcaemia in malignancy is an increased bone
resorption either caused by metastasis or by humoral factors produced by the tumor cell. In Rickets, Coeliac
diseases, idiopathic steatorrhea, osteomalacia, tropical sprue and following surgical resection of the small intestine,
serum calcium is often moderately reduced, usually in association with low plasma protein concentration.
Reference values pertains to age and sex of the patient
**END OF REPORT**
Dr.Manasa H P
Consultant Pathologist
KMC No - 92180
Page 2 of 6
Patient Name : SUDIP BAURI Patient ID :0
Age / Sex : 23 years / MALE Registered On : 11/04/2024, 07.20 PM
Referred by : SELF Received On : 11/04/2024, 07.20 PM
Client Name :Climaveneta Reported On : 12/04/2024, 08:21 PM
SID.No : 957
Department : BIOCHEMISTRY
Test : LIPID PROFILE* ,Serum
Test Description Result Units Reference Range
SERUM APPEARANCE Clear
TOTAL CHOLESTEROL 167 mg/dl Adult :-
CHOD-PAP Desirable : < 200
Borderline : 200 - 239
High Risk : >= 240
TRIGLYCERIDES 178 mg/dL Normal : < 150
GPO-PAP Borderline - High :150 -199
High :200-499
Very high : >=500
HDL CHOLESTEROL 59 mg/dL Risk < 40
Direct Measure Borderline : 40 - 60
Desirable >= 60
LDL CHOLESTEROL 108 mg/dL Optimal : < 100
Direct Measure Above Optimal : 100 - 129
Borderline High : 130 - 159
High : 160 - 189
Very High : >= 220
VLDL CHOLESTEROL 36 mg/dL < 30
NON HDL- CHOLESTEROL 80 mg/dL Optimal : < 130
Above Optimal : 130 - 159
Borderline High : 160 - 189
High : 190 - 219
Very High : >= 190
CHOL / HDL RATIO 2.83 Normal : < 3.3
Low Risk : 3.4 - 4.4
Average Risk : 4.5 - 7.1
Moderate Risk : 7.2 - 11.0
High Risk : > 11.0
LDL / HDL RATIO 1.83 Desirable : 0.5 - 3.0
Borderline : 3.1 - 6.0
Elevated : > 6.0
Comment Value rechecked. Kindly correlate clinically
The lipid panel is frequently used for ongoing monitoring of cardiovascular risk after a person has had high cholesterol
on a prior test or after a previous cardiac event like a heart attack or stroke. In many cases, people who are at higher
Interpretation :
risk of cardiovascular problems make lifestyle changes or take medications to help reduce that risk. A lipid
panel may be used to monitor their response to treatment and adjust their treatment plan as necessary.
Reference values pertains to age and sex of the patient
**END OF REPORT**
Dr.Manasa H P
Consultant Pathologist
KMC No - 92180
Page 3 of 6
Patient Name : SUDIP BAURI Patient ID :0
Age / Sex : 23 years / MALE Registered On : 11/04/2024, 07.20 PM
Referred by : SELF Received On : 11/04/2024, 07.20 PM
Client Name :Climaveneta Reported On : 12/04/2024, 08:21 PM
SID.No : 957
Department : HAEMATOLOGY
Test : BLOOD GROUP & RH TYPING* ,Edta Whole Blood
Test Description Result Units Reference Range
BLOOD GROUP & RH TYPING* B POSITIVE
Comment
Blood Group: A blood type (also called a blood group) is a classification of blood based on the presence and absence
of antibodies and also based on the presence or absence of inherited antigenic substances on the surface of red blood
Interpretation Notes:
cells (RBCs). Determination of blood type is essential so that patients should ideally receive their own
blood or type-specific blood products to minimize the chance of a transfusion reaction.
Reference values pertains to age and sex of the patient
**END OF REPORT**
Dr.Manasa H P
Consultant Pathologist
KMC No - 92180
Page 4 of 6
Patient Name : SUDIP BAURI Patient ID :0
Age / Sex : 23 years / MALE Registered On : 11/04/2024, 07.20 PM
Referred by : SELF Received On : 11/04/2024, 07.20 PM
Client Name :Climaveneta Reported On : 12/04/2024, 08:21 PM
SID.No : 957
Department : HAEMATOLOGY
Test : COMPLETE BLOOD COUNT WITH ESR ,Edta Whole Blood
Test Description Result Units Reference Range
*HAEMOGLOBIN 13.80 g/dL 12-15
Cyanide free SLS method
*PACKED CELL VOLUME- PCV 39.50 % 36-46
Hydro dynamic focussing DC detection method
*RED BLOOD COUNT - RBC 5.70 million/cumm 3.8 - 4.8
Hydro dynamic focussing DC detection method
*MEAN CORPUSCULAR VOLUME-MCV 87.00 fL 83 - 101
Derived from impedance
*MEAN CORPUSCULAR HAEMOGLOBIN-MCH 28.00 pg 27-33
Derived from impedance
*MEAN CORPUSCULAR HAEMOGLOBIN 30.00 g/dl 30-35
CONCENTRATION-MCHC
Derived from impedance
*TOTAL WBC COUNT 10.40 Cells/cumm 4.0 - 11.0
Fluorescent flowcytometry
NEUTROPHILS 53 % 40-75
Fluorescent flowcytometry
LYMPHOCYTES 39 % 20-45
Fluorescent flowcytometry
EOSINOPHILS 3 % 1-6
Fluorescent flowcytometry
MONOCYTES 5 % 1.0 - 10
Fluorescent flowcytometry
BASOPHILS 0 % 0-2
Fluorescent flowcytometry
*PLATELET COUNT 346 10^9/L 150-450
Hydro dynamic focussing DC detection method
ERYTHROCYTE SEDIMENTATION RATE (ESR) 14 mm/hr Normal: 5 - 20
In pregnancy (First half) : Upto 48 In
pregnancy (Second half) : Upto 70
TEST INTERPRETATION : CBC done by 5-part cell counter.
Comment : Reference values pertains to age and sex of the patient
**END OF REPORT**
Dr.Manasa H P
Consultant Pathologist
KMC No - 92180
Page 5 of 6
Patient Name : SUDIP BAURI Patient ID :0
Age / Sex : 23 years / MALE Registered On : 11/04/2024, 07.20 PM
Referred by : SELF Received On : 11/04/2024, 07.20 PM
Client Name :Climaveneta Reported On : 12/04/2024, 08:21 PM
SID.No : 957
Department : CLINICAL PATHOLOGY
Test: Urine Routine*, Urine
Test Description Result Units Reference Range
PHYSICAL EXAMINATION
Colour Pale Yellow Pale Yellow/ Yellow/ Yellowish
Volume 5 ml
Appearance Clear Clear
Reaction (PH) 6.5 4.8 - 7.6
Specific Gravity 1.002 1.010 - 1.030
CHEMICAL EXAMINATION
Urine Albamin Absent Absent
Method: Benedict's
Urine Sugar Absent Absent
Method: Benedict's
Ketone Bodies Negative Negative
Method: Rothera's test
Bile Salt Absent Absent
Method: Hay's Test
Bile Pigement Absent Absent
Method: Gmelin's Test
MICROSCOPIC EXAMINATION
Pus Cells 1-2 /hpf < 4 /hpf
Epithelial Cells 1-2 /hpf < 4 /hpf
RBC 's Nil Nil
Crystals Nil -
Casts Nil -
**END OF REPORT**
Dr.Manasa H P
Consultant Pathologist
KMC No - 92180
CONDITIONS OF LABORATORY TESTING AND REPORTING
Laboratory results should be used with other clinical information to determine a final diagnosis.
In case of unexpected test results please contact the laboratory. We will investigate and repeat analysis if possible.
The medical report must be viewed and reproduced as a whole.
This medical report is not intended for any medico-legal purposes.
Assays are performed and reported in accordance with the stated schedule.
There may be circumstances beyond our control that delay results, e.g., invalid assay run.
The results of a laboratory test are dependent on the quality of the sample as well as the assay procedure.
A requested test may not be carried out if: 1. Sample is insufficient or inappropriate. 2. Sample
quality is unsatisfactory. 3. Request for testing is withdrawn by the ordering doctor or patient.
For any enquiries, Contact the lab @ 7795830112
Page 6 of 6
EYE CHECKUP REPORT
SI NO 122 DATE: 11/04/2024
NAME: SUDIP BAURI AGE: 23 YRS
EMP ID: 0 GENDER: MALE
VISUAL ACUITY:
Distance vision Near vision Color Vision Styes Eye Power
RIGHT: 6/6 N-6 Normal Normal
PLANO
LEFT: 6/6 N-6 Normal Normal
IMPRESSION: PLANO
Eye Test Method:
20-25 (Snellen) at 16”(40.64 cm- +/-1”(2.54cm)
Jaeger No.1 at not less than 12”(30.48cm)
Colour Vision: Test – ISHIHARA colour book with 38 plates
Signature of the Examiner
AUDIOMETRY REPORT
SI NO 122 DATE: 11/04/2024
NAME: SUDIP BAURI AGE: 23
EMP ID: 0 GENDER: MALE
Department STORE
AUDIOGRAM
LEFT FREQUENCY IN HERTZ(HZ) RIGHT FREQUENCY IN HERTZ(HZ)
EAR PTA
LEFT 10 - 30db
RIGHT 10 - 30db
AUDIOLOGICAL INTERPRITATION: Both The Ears are Within Normal Hearing Limits
Recommendations : No
AUDIOMETRIST
Note: Air Conduction Screening Test Done in a Non Audiological bhoot.
