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The Medical Singapore form is a crucial document for students seeking admission to various courses at Singapore Polytechnic. This form serves multiple purposes, including collecting personal information, medical history, and family background, all while ensuring confidentiality. Students must be aware of specific medical conditions that may disqualify them from pursuing certain courses, such as colour vision deficiency or epilepsy. The form is divided into two parts: the first section is to be completed by the student, detailing personal particulars and medical history, while the second part requires the assessment of a registered medical practitioner in Singapore. This practitioner will evaluate the student's fitness for the chosen course, taking into account any potential health concerns. Furthermore, students are informed about the necessity of undergoing a medical check-up and possibly additional tests, with clear instructions on how to proceed. The form emphasizes the importance of accuracy in the information provided, as it directly impacts course eligibility and future academic pursuits.

Medical Singapore Example

MEDICAL REPORT (2014)

Medical Report Form

Admission Number

(This medical report will not be returned to the student)

This form may take you 3 minutes to ill. The data provided will be kept strictly conidential and used for the purpose of assessing itness for admission to a course.

Students with the following medical conditions should not pursue the respective courses stipulated.

If you are suffering from colour vision deiciency, you should not pursue the following courses:

-

Applied Chemistry with

-

Chemical Engineering

- Food Science & Technology

 

Pharmaceutical Science

- Electrical & Electronic Engineering

-

Marine Engineering

-

Biomedical Science

-

Engineering Systems

-

Nautical Studies @

-

Biotechnology

 

 

 

 

@Student must pass the Maritime and Port Authority of Singapore Sight Test.

If you are suffering from either colour vision deiciency or hearing loss (partial or complete), you should not pursue the following courses:

- Aeronautical Engineering

- Aerospace Electronics

- Energy Systems and Management

If you are suffering from or have a history of epilepsy, you should not pursue an Engineering course.

For the Computer Engineering course, if you are suffering from impairments, you must be prepared to appear for interviews and to undergo any manual dexterity or aptitude tests.

For the Visual Effects and Motion Graphics course, if you are suffering from colour vision deiciency, you will be required to attend an interview to determine your suitability for admission to the course.

Students with Autism / Asperger Syndrome may be referred to a psychiatrist to help them to prepare for a new learning environment.

PART 1 – TO BE COMPLETED BY STUDENT

APersonal Particulars

Name:

 

 

 

 

 

 

NRIC / Foreign Identiication:

 

Date of Birth:

 

Course:

 

 

 

 

Tel:

 

 

 

Handphone:

 

 

Gender: Male / Female

B Medical Information

 

1. Family Doctor / Clinic:

Tel:

2.Do you have or have you ever had any of the following conditions? Please indicate by checking ( ) the appropriate column. If your answer is 'Yes', give details (#) below and attach medical report (if necessary):

 

Yes

No

 

Yes

No

 

Yes

No

Active Tuberculosis

 

 

Autism / Asperger Syndrome

 

 

Hearing Loss

 

 

Allergies

 

 

Colour Vision Deiciency

 

 

HIV Positive / AIDS

 

 

Asthma

 

 

Diabetes

 

 

Hypertension

 

 

Attention Deicit Hyperactivity

 

 

Dyslexia

 

 

Psychiatric Condition

 

 

Disorder (ADHD / ADD)

 

 

Epilepsy

 

 

Vision Loss (excluding myopia)

 

 

Other Medical Conditions:

 

 

Other Physical Disability:

 

 

(#) Details:

3.Please provide your Family, Social and Drug history by checking below. If your answer is 'Yes', give details.

Yes

No

Details

i)Family History

Diabetes Hypertension Heart Disease Psychiatric Condition Stroke Tuberculosis

ii)Social History

Smoking

Number of sticks per day :

(Smoking is a disciplinary offence on campus.)

Alcohol

 

 

iii)Drug History

Drugs taken presently

Allergies

I hereby declare that all the information provided is true and accurate to the best of my knowledge and I have not deliberately omitted any relevant fact. I agree to a medical practitioner completing the form overleaf for submission to SP on my behalf.

Student's Signature:

 

Date:

Name :

 

Admission No :

 

Course :

PART 2 – TO BE COMPLETED BY A MEDICAL PRACTITIONER REGISTERED IN SINGAPORE ONLY

 

Height (m) :

 

 

 

BMI =

Weight in kg

 

Urine Analysis:

Glucose

 

 

 

 

 

 

 

 

 

 

 

 

 

-------------------

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Weight (kg) :

 

 

 

 

 

(Height in m)2

 

 

Protein

 

 

 

 

 

 

 

 

 

 

 

 

 

If BMI > = 23 (moderate -

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BMI :

 

 

 

 

 

 

 

 

high risk)

 

 

Blood

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Acuity of Vision

 

 

 

 

 

 

 

 

Colour Vision (tick one only)

 

 

 

 

 

 

 

 

 

 

 

 

 

R

 

L

 

Ishihara Test

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Without glasses

 

 

 

 

 

 

 

 

 

 

Normal

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

With glasses

 

 

 

 

 

 

 

 

 

Partial: Red / Green deiciency

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

History of Epilepsy:

 

Yes

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If yes,

 

 

 

 

 

 

 

 

Complete: Red / Green deiciency

 

 

 

 

 

Recovered

 

 

Still on Medication

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Chest X-Ray Report:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PHYSICAL EXAMINATION

 

 

 

 

 

Eyes :

 

 

 

 

 

 

 

 

Blood Pressure :

 

 

 

 

 

Ears :

 

 

 

 

 

 

 

 

Pulse :

 

 

 

 

 

Nose :

 

 

 

 

 

 

 

 

Heart :

 

 

 

 

 

Teeth :

 

 

 

 

 

 

 

 

Abdomen & Pelvis :

 

 

 

 

 

Gums :

 

 

 

 

 

 

 

 

Hernia (Enlarged Rings) :

 

 

 

 

 

Tonsils :

 

 

 

 

 

 

 

 

Skin :

 

 

 

 

 

Back / Spine :

 

 

 

 

 

 

 

 

Mental Disposition :

 

 

 

 

 

Injury, Operation, Illness:

 

 

 

 

 

 

 

 

 

 

 

 

 

Referrals (All fees are to be borne by the student.)

-Those with or suspected to have psychiatric condition must be referred to a psychiatrist for further assessment.

-Those with epilepsy must be referred to a Designated Workplace Doctor who will assess their itness for courses.

Blood Test (May be required at the discretion of the Medical Practitioner. All fees are to be borne by the student.) Test Result :

Certiication of Fitness

1.I have today completed a medical examination of the person named overleaf and ind this student for admission to be free / not free* from organic and infectious diseases.

2.The student is physically and mentally

Fit / Unit* to pursue the course indicated.

Fit / Unit* to pursue Any Other Course / Other Courses*

Remarks (if any) :

* Please delete accordingly. The student is deemed unit unless certiied it.

To be completed by the Medical Practitioner if the student is enrolling for the Diploma in Marine Engineering / Nautical Studies Course only

Diploma in Marine Engineering Course

The student is it / unit* to be employed on board ship as Cadet Engineer / Engineer Oficer.

Diploma in Nautical Studies Course

The student is it / unit* to be employed on board ship as a Cadet Deck Oficer.

Name of Registered Medical Practitioner:

Qualiications:

 

 

 

 

 

(Signature of Doctor)

(OFFICIAL STAMP)

 

 

Name and Address of Practice:

 

 

 

 

 

 

Date:

 

Medical Check-Up and X-Ray for Full-Time Courses

Successful Applicants of all Full-Time courses are required to undergo a medical check-up and X-ray.

Bring along your SP Medical Report Form to the clinic. You may go to your own family doctor, private or company clinics for the medical check-up. Should you choose this option, please submit your medical report personally at Student Service Centre (Blk T16 Level

1)or mail in to Admissions Ofice, Singapore Polytechnic, 500 Dover Road, Singapore 139651 as soon as you have received it from your doctor.

Alternatively, you may go to any one of the clinics listed. Those who go for their medical check-up at the clinics listed will have their SP Medical Report dispatched to us by the clinics.

All full-time international students are required by the Immigration & Checkpoints Authority (ICA) to undergo a medical check-up with HIV testing. Please have both the SP and ICA Medical Examination Report Forms when you go to the clinic for your medical check-up. You will have to collect the ICA medical report from the clinic when it is ready.

Students will bear all medical charges including any referrals to Designated Workplace Doctors or other Specialists.

If the doctor has recommended you to undergo a blood test, the cost of this blood test is additional. Initial blood test is estimated at S$20.00.

Please inform the Admissions Ofice immediately should you have a medical condition that prohibits you from pursuing the offered course (e.g. colour vision deiciency). SP will need to arrange for a course transfer.

Call 6772-1882 or email [email protected] with Subject Title: Medical Condition and provide your Name, Admission Number and Course Offered.

Clinics

Opening Hours

 

 

SATA CommHealth

You may wish to avoid the peak periods: weekday mornings and Saturdays as waiting times can be stretched. Rate:

• Singaporean / Permanent Resident: S$30.00 (inclusive of 7% GST)

• International Student: S$49.00 (inclusive of 7% GST)

SATA Uttamram Medical Centre

Monday To Friday

(One-Stop Centre with X-Ray Services)

8.30 am to 5.00 pm

351 Chai Chee Street

 

Singapore 468982

Saturday

Tel: 6244-6688

8.30 am to 1.00 pm

MRT Station: Bedok

Weekend Surcharge: S$8.00

Bus Service:

 

222 (from Bedok MRT Station, in front of Blk 27, New Upper Changi Road)

Closed on Sundays & Public Holidays

 

 

SATA Jurong Medical Centre

Monday To Friday

(One-Stop Centre with X-Ray Services)

8.30 am to 5.00 pm

Blk 135 Jurong Gateway Road

 

#04-345

Saturday

Singapore 600135

8.30 am to 1.00 pm

Tel: 6244-6688

Weekend Surcharge: S$8.00

MRT Station: Jurong East

 

Bus Service:

Closed on Sundays & Public Holidays

51, 66, 78, 79, 97, 98, 105, 197, 331

 

 

 

SATA Woodlands Medical Centre

Monday To Friday

(One-Stop Centre with X-Ray Services)

8.30 am to 5.00 pm

900 South Woodlands Drive

 

#04-01 Woodlands Civic Centre

Saturday

Singapore 730900

8.30 am to 1.00 pm

Tel: 6244-6688

Weekend Surcharge: S$8.00

MRT Station: Woodlands

 

Bus Interchange:

Closed on Sundays & Public Holidays

161, 168, 169, 178, 187, 856, 858, 900, 900A, 901, 902, 903, 911, 912, 913, 925,

 

926, 950, 960, 961, 962, 963, 963E, 964, 965, 966, 967, 968, 969, 970, 971

 

 

 

SATA Ang Mo Kio Medical Centre

Monday To Friday

(One-Stop Centre with X-Ray Services)

8.30 am to 5.00 pm

Blk 715 Ang Mo Kio Avenue 6

Evening Clinic

#01-4008 / 4010

Singapore 560715

6.00 pm to 9.00 pm

Tel: 6244-6688

Surcharge: S$5.00

MRT Station: Ang Mo Kio

 

Bus Interchange:

Saturday

13, 86, 138, 162, 851, 852, 853

8.30 am to 1.00 pm

 

Weekend Surcharge: S$8.00

 

Closed on Sundays & Public Holidays

 

 

• Singaporean / Permanent Resident: S$28.00 (inclusive of 7% GST)

 

• International Student: S$47.50 (inclusive of 7% GST)

 

 

 

Ang Mo Kio – Thye Hua Kwan Hospital

Monday To Thursday

17 Ang Mo Kio Avenue 9

8.45 am to 3.30 pm

Singapore 569766

Lunch (Closed):12.00 noon to 2.00 pm

Tel: 6454-8481

 

MRT Station: Yio Chu Kang

Friday and Saturday

Bus Service:

8.45 am to 12.00 noon

76, 265, 268

 

 

Closed on Sundays & Public Holidays

 

Last appointment for AM session is at 11am

 

Last appointment for PM session is at 3 pm

 

 

File Breakdown

Fact Name Details
Form Purpose This form assesses a student's fitness for admission to a course.
Confidentiality The data provided is kept strictly confidential.
Completion Time Students may take approximately 3 minutes to fill out the form.
Medical Conditions Certain medical conditions may restrict course eligibility, such as color vision deficiency.
Required Interviews Students with impairments may need to attend interviews or tests for specific courses.
Doctor's Role A registered medical practitioner in Singapore must complete part of the form.
Medical Check-Up Successful applicants for full-time courses must undergo a medical check-up and X-ray.
Referral Requirement Students with suspected psychiatric conditions must be referred for further assessment.
Cost of Medical Services Students bear all medical charges, including blood tests and referrals.
Governing Law This form is governed by the laws of Singapore.

Guide to Using Medical Singapore

Completing the Medical Singapore form requires careful attention to detail. This process ensures that all necessary information is accurately captured for assessment purposes. Follow the steps below to fill out the form correctly.

  1. Begin with Part 1, which is to be completed by you, the student.
  2. Fill in your personal particulars including your name, NRIC or Foreign Identification number, date of birth, course, telephone number, handphone number, and gender.
  3. In the Medical Information section, provide the name and contact number of your family doctor or clinic.
  4. Indicate whether you have or have had any specified medical conditions by checking the appropriate column (Yes or No). If you answer 'Yes', provide additional details and attach a medical report if necessary.
  5. Complete your Family, Social, and Drug history by checking the relevant boxes and providing details where applicable.
  6. Sign and date the declaration at the bottom of Part 1, confirming the accuracy of the information provided.
  7. Proceed to Part 2, which must be filled out by a registered medical practitioner in Singapore.
  8. Ensure the medical practitioner completes the sections on height, weight, urine analysis, vision acuity, and physical examination.
  9. Have the medical practitioner assess your fitness for the course and sign the form, including their official stamp.
  10. Submit the completed form to the appropriate office, either in person or by mail, as instructed.

Get Answers on Medical Singapore

What is the purpose of the Medical Singapore form?

The Medical Singapore form is designed to assess a student's fitness for admission to a course. It collects personal and medical information, which is kept confidential and used solely for this purpose. Students must provide accurate details about their health conditions, as certain medical issues may restrict their ability to pursue specific courses.

Who needs to complete the Medical Singapore form?

All students applying for full-time courses at Singapore Polytechnic are required to complete this form. It must be filled out by the student and then reviewed by a registered medical practitioner in Singapore. This ensures that all relevant health information is accurately reported and assessed.

What should I do if I have a medical condition that may affect my course eligibility?

If you have a medical condition that may prevent you from pursuing your chosen course, it is important to inform the Admissions Office immediately. You can do this by calling 6772-1882 or emailing [email protected]. Include your name, admission number, and the course you were offered. This allows the institution to consider arranging a course transfer if necessary.

What are the costs associated with the medical check-up?

Students are responsible for all medical charges, including the cost of the check-up and any referrals to specialists. For instance, the initial blood test is estimated to cost around S$20.00. Additionally, different clinics may have varying fees for the medical check-up, with Singaporean or Permanent Resident students typically paying around S$30.00, while international students may pay S$49.00.

Common mistakes

Completing the Medical Singapore form can be a straightforward task, but several common mistakes can hinder the process. One frequent error is neglecting to provide complete personal particulars. Students often forget to fill in their full name, NRIC or foreign identification number, or date of birth. Missing this information can delay the admission process.

Another mistake involves the medical history section. Many individuals fail to check all relevant medical conditions. If a student has a history of epilepsy or colour vision deficiency, it is crucial to indicate this accurately. Omitting such details can lead to inappropriate course placements, which may affect the student’s future.

Some students also overlook the requirement to attach additional medical reports when necessary. If a condition is marked as 'Yes,' the form requests further details and documentation. Failing to include these reports can result in an incomplete submission.

In the social and drug history section, individuals sometimes provide vague answers. Specificity is essential. For example, stating "I smoke" without indicating the number of sticks per day does not provide a clear picture of the student’s habits, which can be significant for health assessments.

Another common oversight is the failure to sign and date the declaration at the end of Part 1. This signature confirms that the information provided is accurate and complete. Without it, the form may be deemed invalid, requiring resubmission.

Students often forget to review the form before submission. Errors in spelling or incorrect information can lead to complications. Taking a moment to double-check the entries can save time and prevent unnecessary issues.

In addition, some individuals do not follow the instructions regarding the medical practitioner’s section. It is essential that only registered medical practitioners in Singapore complete this part. Submitting a form signed by an unregistered doctor can invalidate the entire document.

Another mistake is not being aware of the specific medical tests required for certain courses. For instance, students applying for marine engineering must be assessed for their fitness to work on board a ship. Not understanding these requirements can lead to unexpected challenges later.

Moreover, students often neglect to keep a copy of their completed form. Having a personal record can be useful for reference and follow-up. This simple step can help in resolving any discrepancies that may arise.

Lastly, many students do not reach out for assistance when they encounter difficulties. The admissions office is available to help clarify any uncertainties regarding the form. Seeking guidance can prevent errors and ensure a smoother application process.

Documents used along the form

The Medical Singapore form is an essential document for students seeking admission to various courses. It collects personal and medical information to assess the fitness of applicants. Along with this form, several other documents may be required to ensure a comprehensive evaluation of a student's health and suitability for their chosen course. Below is a list of these documents.

  • Medical Examination Report: This report provides a detailed account of the medical examination conducted by a licensed practitioner. It includes findings on the student's physical and mental health.
  • Immunization Records: This document lists the vaccinations a student has received. It is often required to ensure that students are protected against certain diseases.
  • Health History Questionnaire: A form that collects information about the student’s past medical history, including any chronic conditions or previous surgeries.
  • Vision and Hearing Test Results: These results are necessary for courses that require specific sensory capabilities, ensuring that the student meets the necessary standards.
  • Blood Test Results: Depending on the course, students may need to provide results from blood tests to check for certain health conditions.
  • Psychiatric Evaluation Report: For students with mental health concerns, this report assesses their readiness for the academic environment and any support they may need.
  • Referral Letters: If a student has a medical condition that requires further evaluation, a referral letter from a healthcare provider may be necessary.
  • Consent Form for Medical Treatment: This form allows healthcare providers to administer necessary medical treatment or perform tests as required during the evaluation process.
  • Course-Specific Health Requirements Document: Some courses may have additional health requirements that students must meet, detailed in this document.
  • Insurance Information: Proof of health insurance coverage may be required to ensure that students can access medical care if needed.

These documents collectively help to ensure that students are fit for their chosen courses and that any potential health issues are addressed appropriately. It is important for students to gather all necessary paperwork to facilitate a smooth admission process.

Similar forms

  • Medical History Questionnaire: Similar to the Medical Singapore form, this document collects comprehensive medical history from patients, including past illnesses, surgeries, and current medications. Both forms aim to assess an individual's health status for specific purposes.
  • Health Assessment Form: This form is used to evaluate a person's overall health and fitness for certain activities or programs. Like the Medical Singapore form, it requires personal and medical information to ensure suitability for participation.
  • Fitness for Duty Certificate: This document certifies whether an individual is fit to perform specific job duties. It parallels the Medical Singapore form in assessing physical and mental health related to course admission.
  • Pre-Employment Medical Examination Form: Employers often require this form to ensure candidates are medically fit for work. Similar to the Medical Singapore form, it includes health history and examination results to determine fitness.
  • Student Health Record: Educational institutions use this document to track student health information, including immunizations and medical history. It is akin to the Medical Singapore form in its focus on health assessment for educational purposes.
  • Physical Examination Report: This report provides a detailed overview of an individual's physical health status, much like the Medical Singapore form, which includes sections for physical examination results and medical history.
  • Clinical Assessment Form: Used by healthcare providers to evaluate a patient's health, this form shares similarities with the Medical Singapore form in its structured approach to collecting health-related data.
  • Occupational Health Questionnaire: This document assesses health risks associated with specific occupations. It is similar to the Medical Singapore form in that it identifies medical conditions that may affect a person's ability to perform certain tasks.
  • Emergency Contact and Medical Information Form: This form collects vital health information and emergency contacts for individuals. It mirrors the Medical Singapore form in its emphasis on personal medical details for safety and preparedness.
  • Immunization Record: This document tracks vaccinations and is essential for school or job requirements. Like the Medical Singapore form, it ensures that individuals meet specific health criteria for admission or employment.

Dos and Don'ts

When filling out the Medical Singapore form, here are four important things to do and avoid:

  • Do: Ensure all personal details are accurate, including your name, date of birth, and course.
  • Do: Disclose any medical conditions honestly. This helps in assessing your fitness for the course.
  • Do: Attach any necessary medical reports if you answer 'Yes' to any health conditions listed.
  • Do: Sign and date the form to confirm that the information provided is true and complete.
  • Don't: Omit any relevant medical history. This could affect your admission process.
  • Don't: Leave sections blank. Fill out every part of the form to avoid delays.
  • Don't: Forget to check the specific requirements for your chosen course, especially regarding medical conditions.
  • Don't: Submit the form without reviewing it for errors or missing information.

Misconceptions

Misconceptions about the Medical Singapore form can lead to confusion and misunderstanding regarding its purpose and requirements. Here are ten common misconceptions, along with clarifications:

  1. All medical conditions disqualify students from courses.

    This is not true. While certain medical conditions may restrict admission to specific courses, many students with various medical histories can still pursue other programs.

  2. The form is only necessary for international students.

    In reality, both local and international students are required to complete the Medical Singapore form as part of the admission process.

  3. Medical information is shared publicly.

    This misconception is incorrect. The data provided in the form is kept strictly confidential and used solely for assessing fitness for admission.

  4. Students with color vision deficiency cannot study any course.

    This is misleading. While certain courses may be restricted, students with color vision deficiency can still pursue many other fields of study.

  5. Only serious medical conditions need to be reported.

    All medical conditions, even those that may seem minor, should be disclosed. Full transparency helps ensure appropriate support and accommodations.

  6. A medical practitioner can complete the form without seeing the student.

    This is false. A registered medical practitioner must perform a physical examination of the student before completing the form.

  7. All medical examinations are free of charge.

    Students are responsible for all medical charges, including examinations and any necessary referrals.

  8. Once submitted, the form cannot be changed.

    This is not accurate. If a student's medical condition changes or if they realize they made an error, they can contact the admissions office to update their information.

  9. The form is not important for course admission.

    This is a misconception. The Medical Singapore form plays a critical role in determining a student's fitness for the chosen course and ensuring safety in the learning environment.

  10. Students with Autism/Asperger Syndrome will be automatically disqualified.

    This is incorrect. Students with Autism or Asperger Syndrome may be referred for additional support but are not automatically disqualified from admission.

Key takeaways

Filling out the Medical Singapore form is an essential step for students seeking admission to various courses. Here are some key takeaways to ensure a smooth process:

  • Confidentiality is Key: The information you provide on the form will be kept strictly confidential. It is used solely to assess your fitness for admission to your chosen course.
  • Understand Course Restrictions: Be aware that certain medical conditions may restrict your eligibility for specific courses. For instance, students with colour vision deficiency or hearing loss should not pursue engineering-related fields.
  • Complete All Sections: Ensure that you fill out all required sections of the form accurately. Missing information can delay the processing of your application.
  • Medical Practitioner’s Role: A registered medical practitioner must complete the second part of the form. This includes a physical examination and any necessary referrals for further assessments.

By keeping these points in mind, you can navigate the process more effectively and ensure that your application is handled promptly and accurately.