57
[/'
Ja^, z-o I j l+ ool3zt BA
,u, "$', H.N."f. HOSPITAL, HYDERAffi,&LINSI'ITUTE FOR EAR, NOsE, THROAT AND HEAD & NECK DISEASES
. i ITTIFICATE OF HEARING DXbABILI'I"I \
-ar-:je.:q.,\l.a.'r?r5 - tZr,r.\B\,., lr,, t \\3"',1 3: r_23 )rt..,: :1 ,'.: C.,,,3 !,,'i i,',' )e;' ).!.ra',1r
,3ca. ci r,F3l ,,,s. ^.:. i _,i 'l,i ,:i;3 - r,ti.le.r ;' 15-c-1992
Nonre
O.PNo. qqiti q Diognosis:
r"rh"}{-/rr*u"*s Nome , S-;
16-s",F -oor3A:]5o-b\D
r"l, f-rg;q-r !,\ -L.rQrSigt'11','t '
, I n,mr irrg,,rs55,9., ,lr. ' :. rhe discole,l ;rersonCerri{ied ihol
Son / d6\61"r Z u/i{" oi
of Heorinq Disohility.
n
PRCFOUND - Hecring oiscb;lrD.
on,the f-teoring osiess!'ne.1 cjcne D) ,i"5ielegis. & Speeci: Pothoiogist,
ldentificotion Morks
t,,,,, .--.-94--_- % ,:- ^o,3s
r,o ,/ Sire belongs to he ccr€c.r
:.iiL! ,I/CDERATE @
I nis Cer'liirccr ie is given bosedGow El'ii llospitol, Hyderobod.
(-/4iENT Surgeon
CMI Assl. St tgoo r ' ' ss't ' tot
Uafnb{ Medlc"l uveldOii EI?, HorPllr, Kott' Htl
o
', '- \ :'rhl srrg"i,n--'i ., rn p 1^ ()
llsoclate Professo' r.l J:71r7',
Ofmrn' MCdical , 1rps,s /Govt ENT. Hospit '. A
Percentoge Benelits
* No Speciol bene{ir::
4096 ond oboraa i Hcoring oid ot {roe of cosl or concessionol rotes
Heoring oid ol {ree o{ :osl or6elssssisng, r,;is:,
Job reservoliorr
Bonofit of speciol enrul.:,yirronl ex;lronoekholorshipsSingle longuoge forinr! :r
Heoring oidsFocilities of reservotior,
Speciol employrrienl exciion ge
Spcciol {ocilities in schcols like Scholorshi;,s. her:ring oids&cmption from 3 longuoge lormulo_--*.*r
75% onii obove
oi
Less ttron 40 %
I
!
l
-
Ycotn
i. Dr.Dn) /T Gr:pTD2. or.SonD gfletlA3. Dr r\ut<6H TENe,Tb
6. Extentof ResidualVision: R.E.
L.E.
'Degree of Disability / Percentageof Visuallmpairment
State whether he / she is eligible forGovernment assistance
LT7 oF4 . sai k)rar-t
Applicant /Thumb lmpression
Date : 28 -o6. Zoll
Dr. MUK ,ril(r^Ophthalmologist
Member-Medical BoardElaa Na 1n?6?
Jau -l\ 1+ooo lz11
ResdNo. HN l8+Resd No. 74 l3LResd No. I O 26 3
MEDICAL BOARD Cert. Regd. No p2Zft;,
r. V PRASAD EYE INSTITUTE . BANJARA HILLS, HYDERABADMedical certificate in Respect ofrvisuaily handicapped candidate
GO. No. 18595 lF1 I 2001 - 2 Government of Andhra pradeshHealth, Medical and Family Welfare (Fl) Department Dated : 1g
:t
I
I
'lI
I
certified that we have this e 5 day of 06 z0 I I examined thjare given below.
1. Name of the Candidate
2. S/o. Effiq#cr
3. Age/Gender
4. ldentification Marks
NR,DNIDDLE SD(KIRDN/nR, E.PRDBHD4EP, qouD
zo f nDtstdh;L sk)o
5. Cause of Blindness OCU t-o.curftN Eou.1 A16rNlr M
D scatw ort *Ao- ,lgrLt ke,^.|
zo lzooz-tl zno
! t.
t
: nS -/.
'\gs
l'i{- !1i
,)
,l{
OphthatmotogistMember-Medical Board
wDr. AIIT CUpffOphthatmotooast
ll cm bc r-M crt ica i Boc rd. ., [9g.Nq.HN tE,t8
4-// _\\erllrt \ /nrn\1-jtrl \/ t/ r l/ JT
ss
w
nd -_11;..,'; ., ijlll,'l ro.',
:tot No.ll rt' ,' , ,r. CCIL,-
.9,"JTili ,;i,t' oo=
A
U.N
L.V. Pricad Eye tnatituBanlara Hl[c,
HYDERABAD.sOO 03{
..:
t)eolo7q3
or,/ d*t /*/#" frA "Xrr,n"t da cil"rv,u.
1. N.mcorrhec.noio*"j', &q[*q2. FsrhorbNry &4 {";"rU/U,2. FsthorbNq* &U {b#M,(*il{s. Asc P,y*,
- (/
{. "* -fu/"*ll
s. Rcv ] P-c. 3#rr*,*eFwxr$ , ?PL7. Fickl of vidm
8. . Colour vision l
g. Oegnoob: *
10. Naturs of Disablllty
Edent of dlssHlfty 6r ffifscale cCimete percalilegc)
Whdhcr opgratod or nrrt
Photog:aph arcacO !t{/^, ?11.
12. Pomrrnont Ad<lrsss :
Purposa of th6 Cor(fiort. :
Remarks:
Slgnaturc of tho PCbd/
Thumb lmprsasbn :
.A"-JI P'-fo'* yla
13.
11.
r5. ktorilrfrcaoonmarrc r4-rr?d"e l{L#4elrr"',rco
MPs
Government of Andhra PradeshOffice of the SuperlntendentSarofin[ Devl Eye Hospital,
Humayur NOar. XyUenbad. A.P.
VtIc G.O.Ms.No. 100, Women's Dovoloprh€ril Chlld l/Velfere end Labour Depar{mentU. 15.&92 Compiros thc lollowhe
,kbrl*rJrtd" ,iL*1-*rZ-trr";irhr"rlJru
W Ny+^1*Dr/ -r- L,d- d*rrt
i
t
yJ&p"/Q*s
-*r-,'rq!
ltr
I
d l- e.'e a>1tio7o*{' :
,'l\to 008 '. /L- ?- - 6q>//
qf.rr-//*ffi^1,i*lr*lW-,afr *,r"
Jd.d tlt I LtS0lo74; ytPs
MEDICAL CERTIFICATE FOR THE BLIND(lssued Under Authorily Vide G.O. Ms' No. 109 Women's Develop'
menf,chitd ll/elfore ond Lobou, D"pottmeni, Doted : 15-6-92f '
Certified thot the Diskicl Medicol Boord
hove this doy of 200
exomined the condidole whose porticuolrs ore given bElow'
I . Nome of the Cnnclicjote : I Alslt u ' AA f gSU
2. Folher's Nome , gl0 g'V*Sti DE S*
3. Sex : - HoLEApproximoie Age : t16 tFOf'{ldentificotion Morks :
r) ft s^^^^tr h0\4* &1^ ua- addt^/- .tSo4r CCL
^^rc-2l ft S.y*$"Il t^\AL $-n UG{- ,\a//r. l^or^dExtoni of residuol vision if onY :
1. Risht Eye : l1'0\
.t?r
ossI2eD o
:
iliI,it1
liItI-ls
4.
5.
7.
,. "TrrJ',
'i;. , +|rc ,-\- ^n..^,i'L d,^nro Nh'*/
onsgt of blindness..(Pleose slote whEther @ U+*;*blindness is fronr birthor ocquired loter if tl *tJ"'
,l t;rw*
i,fii,, fi: jJ#:'l*Tl'o,!i*'lf:Tflt @,9 /Q^''
*fi"ilfi !,r'L ',r"'- rrom eirher or the
6 ,fiYtun ,r
8.
9.
cJ Limitotion of the field of vision sub'on
ongle of 20 degree of worse.
N'O
?^(*Pleose stote cleorly whelher the condidote is blind
{or oll the purposes of ossislonce.
Specify wheiher lhe condidote is totolly blind orporiiolly blind.
S.'RCcs,\ *tf-i
$I,
(c [,lq Ji1,.,,,t"'i'i i:,':i:r.r.,',"i[,rf,^,
Sl J r',); c, r s SGNqltJ-fE 6f i,*reotCelo o A Rr,
rteu.rfr,pERtNfnrOE5tfpffn SEe,tlet
SIGNATURE OF TI'IE CANDIDATE
DISTRCTMEDICALBOARD.
.f:
I
. .t',
Bch16u tl
Govtrnnrant of Tclengan,TDENTITY CAND FONP[ f;.SO'Y IIVITH DISA SILTTY
!,lcdlcal Board of DlitrH ltorpital,llyderabad
lD Xo; t6310l8OO3O0C0{155Hame (idr ) : S Kirhore Kumar(sft tu,1r6)
orE ot l3tuc(r.o.trb,tr 6a) : ?$/o4l2015Yatid upto{rs3o.rJa}: Lifetimc ($,}{,!!Q")D.te of 3lr$ (rt#J s6)r 15/12/ 19?8lgc (Jo!tu; ): 37Scr (e{ttu ) ! l.{ile (&{siuQ}Addreii (rlct:iy.l, ) ; {t 6.3-9O1,/b-U-i,
IdentSficati,on ilarkr (r!o"ID Jirrlur ) :
1. A f.lolo On The Lefi Hand .2'*o*arkr6*,Luo wlw{-L Signature/Thumb lmprurlon
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with Disability: 1"52L*1L0L1021j123
:t\1fr%12*1* W",\)rfr&tr
,Wa*Earra Mandul{ a &r s, U ew* rn wi gadm fr abitati *n, t* * qezr *nz V il
is sufl*,riny from 9*rrnanenl di*iabtlily of t*zti*iabtliW sf the, fsll*w*nq rateg*ry:,wrng
The disabilily is in r*lxtian tri his ' z$h*i* \3*rly "
$ub -ty Be *f dl szrbilit T : * st"n *rry*n *,s t s i rm {:t *{ f *;?&'* v*' ttyf i nry
?*rC,e**a** *f drsa*ililY in *is case *s 4'*n/ia t"YouW Eigbt p*rctznl'J"
lte msets lhe f*llg,wi*g phy*ical req*sirern*nts f'or discltarfri& of his dulies.t( ntpu)w\inq with {inExr*,?W*e;:xn p*#*rrtr 'wr'rrk"'rz'y pullinq '*n* px*hi*;
rk b'y, titt\ng,fi**mm pxrtaYffi \,Y*:(k *y xitt;":nq,,*"\fi1-cnrt pxrt*rm w*rk b );
*i E*alur e /1 harnb i m P r *,s:;i o n
af ?*rsan wilh Dt*abililY
r"lil
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Ha*naor-Hllficil golrd-*ffi.,,,hd{*{h.-,
{
Dr rlSHAy EADATEHA."- [email protected]
**'dffiilf;ffi'$tr-*
(NArvxE
. DISABILITY CERfIFICATE
[ilJffih$,"#?;;T::*::1;: il io,*s,r and,,r]AND Aonscrs.errx ,G,*l*, *offi,ffift tt and lll)'""""ige'enot*nl ffimTq
::::::]"0u.&*s*i,**, s,I trrb. rrr q?.
t
ili
o?lg,tffi
(DD) (VrVl1 (yV) """'t"'"'vuars, MalelFernale ,- "l{..fregistration l-to ;- . . !'w'!r, tr U
ffif H-:,. ;X.t ffififfi.:- flff::::::::,en,orF{ouse no :.
:5*#j .;$ :* llffi ;**Xr;-,r_,r,,,ri,1, &} t*e/she is a case of rnultiBle disa,biiitl* Hislher extent of permanent physical$mmCIirrqierrr&isabi*ty rrri u.*i
"r.Ur,p.;;Iilil.rin*, (to be,specified) fortheT::i:'Y-u
a ni il;;; ;;;,,,11 rereva nr disa biriry in th e ra bre berow :-
JI ruz ,J.,,?';mffi;ftp**
No
1..
Oisability
!r
r-ocomotor Disability
Affected paf,of body
Diagnosis . permanenf**physicatr
irnpairmentdisabltity{in %}
.}Z. Low Vision # %s-r"oA d,ffij3,I
5.;6"'
B{indness
Hearing innpairment
aorh Eyesfu--L fil
V,)
btvy,Wt
WMental Retardation*%
Mentaliliness
;r.L;X
- VL*jnf&-' vw,Y
- ^NS,:E
| . rI"/ 5 kp-/ o--kfdC*"&Y
Strike. ou: the dlsa bitities wh i.h}fr ( ,d,reeJ I
i; r ,r:r l
ffi ;Hffi ffi ST{T{J$ J HOS PITAL
{"$tegsry
Stnke out rvhrch is nor applicable " .lr,
ANNEXURE _ N
D*wW 3:l-!_!*_
I':i> rS to certifv that Qlri/Srnr/Kum _*t1_Eyi*rgt_Je*z,spnir'trfeldarrglrter of shri {L1 a/cake** -fut1-.-..- age **{ s *._- sex rlnk*r."lo,rrifi.-,+i^,. ,-.--r- r..t h l-t,.,. lt - t -da. o. , i7 +tty '64-l;*^**^**-riierrrificarir:rr mart< (* llbter.Li alk ry K{r_fr_&.#r(#:;firef,r;;;-,.;.,;,;rt clisahilit.v otrirno*,nu
"\. L.oecmotor or cerebral paisy :qii Sl. * Sortr legs afi'ectccl hHt nor annsr'[i,r, , , $4.,-]ffi**r:,ms ntlectccl (n) Ilrpaired reirch (b) lVcakncss of
.grr1:
,, r1*r +.i,' i ffi[*r{ "-, *U kgx and unr. urieri*d.
. .jI;lt , '"Hl.t.klr: l*g alicctcti {rig}ri or }cl}J-(ii) Inrpaircd rcach (b) \\'e;},xq5s o}'$rip ir) i1t,\ic
-*,:,' I Y** *!!1yn:: *flbctcd (a) Impaircd rcach (b) Wcak,ess <it'gr:ip 1c,) AtarTc ', ,;:," , Sll,; Sun bnck or hips (Cannot sit or stoop)ol:*, 5{\\'- }Iusc'ular ucakncss ancl Iimitcd phtlsical cndurfincc
5-" Pffiwd*ess or Lorv Yisio, : (f) B-BIi,dtudn * partia[1,Rri,ct.t - , ffis-Tlr$rfl
Impairmenf : (i) D-Dcaf (ii) pn * par.riailv Dcai.ti"Wsrf ilr.: rategor v* rvhicho cr is not 3,rppjjoablc)l: IfjT:r_rlln l:-progressive j i"liK"ut'essi'e / likely ro irnpro'e ,'rr,rr likely ro inrprove Re*essess.re*rra{+*,* *nse.is r:ot reconlrrenclecl / is rec.onrn.rendecl after;4 p.iio,t ,t,fl*r, wi*$* *lrlisal.lilit1, in his/her case is $*f "Ve$: ,i:i&r:
n''t
r*q,*n meur for dischargc of'hisiher cluties
:ii I; ** p*.rlbnrr rrrrrk l:-r' rnarriptrlatirrr; riittr lln{g,ri. *,r--{"cs / l.jrri::.r liP - ;:.n Flr.rlorrn ri,orii br. pulling and pushing \,"Jfos i No
(i\ ) F'l{ * r.x* p*rli:rmr rrork hr kncclinq and crouchinr sr.ycs,, N,:i , ] i] - sen prrlbrn: u ork
_b1 bcnrJing.
$7 ' ' 'a ,-,-ycs ,, N,.
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