International student medical examination registration
Name
 
Address

Contact No.
Mobile No.
 
Email Id.
 
Age :
   
Gender:
 
College Name
 
Country:
Passport No:
 
International Case No:
 
Appointment Date:
 
 
 
Consent for HIV Testing
 
Please read the following leaflet carefully or we will read it for you. Information about HIV testing is given in the leaflet. If you accept the information, then please sign the form below.

We try to prevent HIV/AIDS. HIV/AIDS is spreading all over the world. At present, there are no effective medicines or vaccine against HIV/AIDS. HIV is transmitted by following means.

1) Having sexual intercourse with HIV + person without using condoms.
2) If HIV + blood is transfused or infected syringes /needles are used for injection.
3) From HIV + pregnant women to her foetus

Superficial touch, sharing of utensils, insect bites, and kiss will not transmit the infection. It takes approximately 8-10 years for a person to develop symptoms after the person gets infected with HIV by above-mentioned methods.

If you agree, l0 cc of blood will be collected from your vein. There may be slight pain when blood is withdrawn from the vein. Blood will be reconstituted in some time.

We will take some primary information, past history of diseases & information about sexuality related to HIV from you.

This information and your report of HIV will be kept confidential. The report will be available approximately with in 3 weeks.

If you have any queries, don’t hesitate to ask us. We will try to answer your queries.
 
 
 
 
Notes
Please bring following documents at the time of medical check-up :
1. Letter of provisional eligibility & admission / Letter of confirmed admission (original & one Xerox)
2. Original Bank challan of US $ 80/- paid for medical check-up
3. Original Passport ( Note : Nepal / Bhutan students should bring Citizen ship card or passport )
4. Passport size photograph
5. Students are requested to attend medical check-up only after taking heavy break-fast.
6. Please do not come for medical check-up on empty stomach
7. Print the form shown in next window on A4 sheet only