Certificate of mental retardation for benefits and standard format - enabled.in

Certificate of mental retardation for benefits and standard format

Guidelines for various disabilities and procedure for certification:The measurement of loss of function in lower extremity is divided into two components: Mobility and standing components.A fracture of right hip joint bones may affect range of motion of the hip joint.

Locomotor disability is defined as a persons inability to execute distinctive activities associated with moving both himself and objects, from place to place and such inability resulting from affliction of musculoskeletal and/or nervous system.

  • Categories of Locomotor Disability

The categories of locomotor disabilities are enclosed at Annexure-A.

  • Process of Certification

1. Guidelines for Evaluation of Permanent Physical Impairment of Upper Limb

2.Guidelines for Evaluation of permanent physical Impairment in Lower Limb

3. Guidelines for Evaluation of Permanent Physical Impairment of Trunk (Spine)

4.Guidelines for Evaluation of PPI in cases of Short Stature/Dwarftsm

5.Guidelines for Evaluation of Permanent Physical Impairment in Amputees

6.Guidelines for Evaluation of Permanent Physical Impairment of Congenital deficiencies of the limbs

7.Guidelines for Evaluation of Physical Impairments in Neurological conditions

8.Guidelines for Evaluation of Physical Impairment due to Cardiopulmonary

ANNEXURE – B

CERTIFICATE OF MENTAL RETARDATION FOR GOVERNMENT BENEFITS

This is to certify that Shri/Smt./Kum______________________________________________ Son/ Daughter of___________________________________________________ of Village/Town/City ___________________________________with particulars given below:-

a) Age

b) Sex

c) Signature/Thumb impression

CATEGORISATION OF MENTAL RETARDATION

Mild/Moderate/Server/Profound

Validity of the Certificate : Permanent

Signature of the Government

Doctor/Hospital with seal

Chairperson Mental Retardation

Certification Board

Recent attested photograph showing the disability affixed here.

Dated:

Place:

ANNEXURE – B

STANDARD FORMAT OF THE CERTIFICATE

Certificate No.____________

Date____________

CERTIFICATE FOR THE PERSONS WITH DISABILITIES

This is to certify that Shri/Smt/Kum_____________________________________________________________ Son/wife/daughter of Shri____________________________________________________ Age_____________old male/female, Registration No.___________________ is a case of _______________________________________________________________ He/She is physically disabled/visual disabled/speech & hearing disabled and has______% (_______ per cent) permanent (physical impairment/visual impairment/speech & hearing impairment) in relation to his/her ______________________________________________________

Note:-

1. This condition is progressive/non-progressive/likely to impreove/not likely to improve.*

2. Re-assessment is not recommended/is recommended after a period of ______________________________months/years.*

*Strike out which is not applicable.

Sd/- Sd/- Sd/-

(DOCTOR) (DOCTOR) (DOCTOR)

Seal Seal Seal

Signature/Thumb impression of the patient.

Countersigned by the

Medial Superintendent/CMO/Head of Hospital (with seal) Recent attested photograph showing the disability affixed here.

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  1. prem chand baniya age 35 years mental retarded iwant his certificate.want renew from kuchaman city hospital.

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