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Date of Birth
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Physical Status
All Special cases
Total Blindness by birth for both eyes
Total Blindness not by birth for both the eyes
Partial Blindness for both the eyes
Partial Blindness only for right eye
Partial Blindness only for left eye
Acquired Blindness for both the eyes
Acquired Blindness only for left eye
Acquired Blindness only for right eye
Blindness by birth only for left eye
Blindness not by birth only for left eye
Blindness by birth only for right eye
Blindness not by birth only for right eye
Total absence of sight
Visual acuity not exceeding 6/60 or 20/200
Blind for all assistances
Hearing disabled by Birth for both ears
Hearing disabled by birth only for left ear
Hearing disabled not by birth only for left ear
Hearing disabled by birth only for right ear
Hearing disabled not by birth only for right ear
Hearing disabled by birth for right ear - Mild
Hearing disabled by birth for right ear - Moderate
Hearing disabled by birth for right ear - Severe
Hearing disabled by birth for right ear - Profound
Hearing disabled by birth for left ear - Mild
Hearing disabled by birth for left ear - Moderate
Hearing disabled by birth for left ear - Severe
Hearing disabled by birth for left ear - Profound
orthopedically Challenged by Birth – Polio"
Orthopedically Challenged by Birth – Post Polio Paralysis
Orthopedically Challenged not by Birth – Post Polio Paralysis
Orthopedically Challenged by Birth – Hemiplegia
Orthopedically Challenged not by Birth – Hemiplegia
Orthopedically Challenged by Birth – Quadra Rlegia
Orthopedically Challenged not by Birth – Quadra Rlegia
Orthopedically Challenged by Birth – Malunited Fracture
Orthopedically challenged not by Birth – Malunited Fracture
Orthopedically Challenged by Birth – Nerve Paralysis
Orthopedically challenged not by Birth – Nerve Paralysis
Orthopedically Challenged by Birth - Congenial deformity
Orthopedically Challenged not by Birth - Congenial deformity
Orthopedically Challenged by Birth - Limp painful shortening
Orthopedically Challenged not by Birth - Limp painful shortening"
Orthopedically Challenged not by Birth
Congenial deformity acquired – Above Left Knee
Congenial deformity acquired - Below Left Knee
Congenial deformity acquired – Above Right Knee
Congenial deformity acquired Below Right Knee
Congenial deformity acquired - Hip
Congenial deformity acquired – Right Wrist
Congenial deformity acquired – Left Wrist
Congenial deformity acquired – Right hand all Fingers
Congenial deformity acquired – Right hand thumb
Congenial deformity acquired – Right hand index finger
Congenial deformity acquired – Right hand middle finger
Congenial deformity acquired – Right hand ring finger
Congenial deformity acquired – Right hand little finger
Congenial deformity acquired – Left hand all Fingers
Congenial deformity acquired – Left hand thumb
Congenial deformity acquired – Left hand index finger
Congenial deformity acquired – Left hand middle finger
Congenial deformity acquired – Left hand ring finger
Congenial deformity acquired – Left hand little finger
Congenial deformity acquired – Right leg Fingers
Congenial deformity acquired – Left leg Fingers
Congenial deformity acquired - Below Elbow
Congenial deformity acquired - Above Elbow
Congenial deformity acquired - Shoulders
Congenial deformity acquired - Any Other
Orthopedically Challenged due to accident
Orthopedically Challenged due to accident – Post Polio Paralysis
Orthopedically Challenged due to accident – Hemiplegia
Orthopedically Challenged due to accident – Quadra Rlegia
Orthopedically Challenged due to accident – Malunited Fracture
Orthopedically Challenged due to accident – Nerve Paralysis
Orthopedically Challenged due to accident - Congenial deformity
Orthopedically Challenged due to accident - Limp painful shortening
Use of Appliances – Calliper
Use of Appliances - Crutch
Use of Appliances - Shoulder Dis Articulation
Use of Appliances – Prosthesis
Any Surgeries done
Others-which is not mentioned above
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Total Experience
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Above 40
Years
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Annual Salary
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lakhs
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