Download and fill the GP69 Form free pdf

What is a GP69 form?

A TSC GP69 form is a This is a medical examination form. This GP69 form is a mandatory requirement when applying for a Teachers Service Commission (TSC) Number and Certificate. This form must filled by a qualified medical officer in a public health facility.

You may be required to pay a small fee for this service at the Health Facility.

How to get the GP69 TSC Form.

This form is available at no cost. You can download it here for free; The TSC GP69 Medical Form Free Download.

How to fill the GP69 Medical Report Form

The GP69 form contains two parts. Part one contains the name of the applicant and the signature and designation of the medical officer. It is completed in duplicate by the officer sending the candidate to the medical examination.

Part two of this form is the medical report that is completed by the medical officer. Before completing the medical report, the medical officer subjects the candidate to a number of medical tests before giving the final report.

THE TSC GP69 MEDICAL REPORT FORM

(To be completed in DUPLICATE)
G.P. 69
REPUBLIC OF KENYA
_________
PART I
(Name and address of Ministry/Department)
……………………………………………..
……………………………………………..
………………………………………………………

To: The Medical Officer i/c …………………………………….
Name: *Mr/Miss/Mrs ……………………………………… is sent herewith for medical examination as a candidate for *temporary/contract/permanent employment/fitness to extend tour by …………….. months

(C.O.R. N.20 (1) as…………………….. in this *Ministry/Department.
………………………………….. (Signature)
………………………………….. (Designation)

Part 2

CERTIFICATE OF MEDICAL EXAMINATION
I HEREBY CERTIFY that I have this day examined the above named candidate and that in my opinion *he/she is *fit/unfit for *temporary/contract/permanent service/extension of tour by ………………………. Months (C.O.R. N20 (1)) as …………………………………. in the Kenya Government Administration.

……………………………….. Station ………………………………..Medical Officer
………………………………, 20 ……

Notes

Part 1 of the form to be completed in duplicate by the officer sending the candidate for examination.
Part 2 of the form to be completed by the Medical officer, who will return one copy to the Ministry/Department which sent the candidate. Particulars on reverse to be filled in by candidate before appearing for Medical Examination.

*Delete whichever is inapplicable.

Candidate’s full name (in BLOCL letters) ……………………………………………………………………
…………………………………………………………………………………………………………………

The following questions to be answered by the candidate:

have you ever been an in-patient in hospital or nursing home suffering from any disease or injury?
If so, give dates, state nature of disease or injury, which hospital or nursing home. Name of doctor(s) who treated you and whether an operation was performed ….…………………………… ………………………………………………………………………………………………………. ……………………………………………………………………………………………………….………………………………………………………………………………………………………..……………………………………………………………………………………………………..
Apart from above, have you ever received medical treatment for any serious disease or injury? If so, give particulars.
………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………………………………………………

Signature of Candidate
____
GPK

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