AGE ESTIMATION FORM

 

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AGE ESTIMATION FORM

 

PARTICULARS

1.       NAME :................................................................................................................

2.       FATHER’S/HUSBAND’S NAME :...................................................................

3.       ADDRESS :.........................................................................................................

4.       DATE OF BIRTH :.............................................................................................

5.       IDENTIFICATION MARKS :...........................................................................

 

CONSENT OF FACTORY WORKER:

I HEREBY CONSENT WITH FULL KNOWLEDGE AND CONSCIOUSNESS FOR MEDICAL EXAMINATION TO THE CONCERNED PHYSICIAN TO ESTIMATE MY AGE.

SIGNATIRE/THUMB IMPRESSION.............................................................DATE.........................................................................

MEDICAL EXAMINATION (DONE IN BROUGHT DAY LIGHT AND OREVACY)

1. HEIGHT :..............................................................................................2. WEIGHT :......................................................................

MINIMUM HEIGHT 4’8”/142CM.MINIMUM WEIGHT 38KG FOR MALE (20-25): FEMALE (19-24) YEARS ACCORDING TO B.M.I RANGE.

3. TEETH

O   L.T.INCISORR

O   INCISOR

O   CANINE

O         O 2ND         1ST   PREMOLAR

O     O     O 3RD   2ND      1ST   MOLAR

               

 

 

 

 

 

SOME LAND MARKS : SECOND MOLAR : ERUPTS 12 TO16 YEARS, THIRD MOLAR ERUPTS : 17 TO 25 YEARS. AT THE AGE OF 17 YEARS NEWLY ERUPTED SECOND MOLAR PROMINENT GRADUAL SPACE SHOWING FOR THIRD MOLAR.

                                                                                8/7 & 8/7=30 AT 19 YEARS, 7/7 & 7/7 = 28 AT 14-18 YEARS

NO

YES

4. GENERAL CONFIGURATION:

BOYS: MUSCULARITY PRESENT IN APPEARANCE

	WELL DEVELOPED		NOT WELL DEVELOPED

 

GIRLS: BREAST

                                               

                                                AT THE AGE OF 19                           AT THE AGE OF 14 – 17

                ALTERATION OF VOICE (16-18 YEARS) MARKED........................NOT MARKED...................

5. PUBERCHE : (ON SET OF GROWTH OF HAIR ON PUBIS AN AXILLA

GIRLS AT ABOUT 13-14 YEARS : BOYS AT ABOUT 14-15 YEARS)

 

FULLY GROWN                                                 NOT FULLY GROWN

 

GROWTH OF HAIR ON CHIN AND UPPER LIPS (IN CASE OF MALE)

 

FULLY GROWN                                                                 NOT FULLY GROWN

                                                                                                                (14-14)

6. MENSTRAUL HISTORY: INCASE OF FEMALE ON AVERAGE STARTS AT 13-15 YEARS DEPENDS ON DIETETIC AND CLIMATIC FACTOR. ONSET OF MENSTRUATION DATE:......................................................

DOCTOR’S COMMENTS

BASED ON ABOVE FINDINGS ESTIMATD AGE OF THIS FACTORY WORKER IS ................................YEARS.

 

 

 

SIGN & SEAL OF DOCTORS