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APPENDIX – II

            Brief particulars relating to the services/posts to which recruitment is being made through this examination are given below: -

1.            Assistant Divisional Medical Officer in the Railways:

(a) The post in Group A – The scale of the post is Rs.8000-275-13,500 (Revised Scale) plus restricted non-practising allowance as per orders in force from time to time. The rate at present is 25% of the basic pay drawn.

            The candidate will be bound to observe the orders which the Ministry of Railways or any higher authority may issue from time to time restricting or prohibiting private practice by him. The candidates in Governernment service will be given initial pay in the above mentioned scale according to rules and others will be given the minimum of the pay scale mentioned above.

(b)       A candidate will be appointed on probation for a period of one year which may be extended by the Government if considered necessary. On satisfactory completion of the probation candidates will be eligible for confirmation in the junior scale of the Indian Railway Medical Service.

(c)        The appointment of probationers can be terminated by one month’s notice in writing on either side during the period of probation in terms of Rule 301(3) of the Indian Railway Establishment Code, Volume – I. Such notice is not however, required in cases of dismissal or removal as a disciplinary measure after compliance with the provisions of Clause (2) of Article 311 of the Constitution and compulsory retirement due to mental or physical incapacity.

(d)       A candidate will have to undergo training as prescribed by the Ministry of Railways and pass all the Departmental Examinations.

(e)       A candidate will be governed by the “Contributory pension system” effective from 01.01.2004 as per orders of the Government.

(f)         A candidate will be eligible for leave in accordance with the leave rules as in force from time to time and applicable to officers of his status.

(g)       A candidate will be eligible for free Railway Passes and Privilege Ticket Orders in accordance with the rules in force from time to time.

(h)        A candidate will be required to pass the examination in Hindi of an approved standards within the period of probation and failure to do so shall involve liability to termination of service.

(i)         Under the rules every person appointed to the above post shall, if so required be liable to serve in any Defence Service or post connected with the Defence of India for a period of not less than four years including the period spent on training, if any.

Provided that such person:

  (a)               Shall not be required to serve as aforesaid after the expiry of ten years from the date of such appointment.

(b)               Shall not ordinarily be required to serve as aforesaid after attaining the age of 45 years.

(j)            Reckoning Service: The persons who are recruited under these rules to posts to which the conditions prescribed in Rule 45 of Railway Service (Pension) Rules, 1993 are applicable shall be eligible to the benefit of the provisions contained in rule.

(k)        A candidate will be governed in respect of matters specifically referred to above as well as other matter by the provisions of the Indian railway Establishment Code and the extant orders as amended/issued from time to time.

(l)         In the first instance a candidate will be posted to the Railway Health Units/Dispensaries at way side Stations, ADMOs are also liable to transfer to any Railway.

(m)            Prospects of promotion including pay scales and allowances attached to higher grades.

(i)           Assistant Divisional Medical Officers with four years service in the grade rendered after appointment thereto on a regular basis are eligible for promotion to the post of Divisional Medical Officers (Senior Scale of Rs. 10,000 – 15,200) plus restricted non-practicing allowances as given in (a) above.

(ii)         Divisional Medical Officers/Senior Medical Officers with six years service in the grade rendered after appointment thereto on a regular basis or on completion of 10 years regular service as Assistant Divisional Medical Officer and Divisional Medical Officers/Senior Medical Officer of which at least two years regular service shall be as Divisional Medical Officer/senior Medical Officer are eligible for promotion to the posts of Medical Superintendents in the scale of rs. 12,000 – 16,500 plus non-practising allowance at 25% of basic pay drawn.

(iii)       Depending upon the number of years of service in the grade of Rs. 12,000 – 16,500 as prescribed from time to time Medical Superintendents become eligible for promotion to the post of Chief Medical Officers in the scale of Rs. 18,400 – 22,400 plus non-practising allowance at the rate of 25% of the basic pay drawn.

(n)        Duties and Responsibilities:

            Assistant Divisional Medical Officers

(i)                 He will attend the indoor wards, and out patient department daily and as required.

(ii)               He will carry out physical examination of candidates and of employees in service in accordance with the regulations in force.

(iii)             He will look after family planning, public health and sanitation in his jurisdiction.

(iv)              He will carry out examination of vendors.

(v)                He will be responsible for discipline and proper discharge of duties of the Hospital Staff.

(vi)              He will carry out duties assigned to him specially if any and will prepare returns and indents connected with his speciality.

(vii)            He will maintain and upkeep of equipments in his charge.

NOTE 1.            When in ADMOs is posted at the Headquarter of a division under the charge of Divisional Medical Officer he will assist the Divisional Medical Officer in all his duties but may be specailly assigned with certain duties and responsibilities.

NOTE 2.            ADMOs will also be required to perform such other duties as may be assigned to them from time to time.

II. Post of Assistant Medical Officer in the Indian Ordinance Factories Health Service under the Ministry of Defence:

(a)               The posts are temporary in Group A but likely to be made permanent in due course. The scale of pay is Rs. 8000 – 275 – 13,500 plus non-practising allowance (NPA) as per orders in force from time to time. The rate at present is 25% of basic pay.

(b)               The candidates will be on probation for a period of 2 years from the date of appointment which may be curtailed or extended at the discretion of the Competent Authority. On satisfactory completion of the probation period he will continue in the temporary post till confirmed against the permanent vacancy.  

(c)               The candidate can be posted anywhere in Indian in any one of the Ordinance Factory, Hospitals or Dispensaries.

(d)               Private practice of any kind whatsoever is prohibited.

(e)               The appointment can be terminated on one month’s notice on either side during the period of probation and thereafter while employed in temporary capacity. The Government reserves the right to give one month’s pay in lieu of notice.

(f)                 Prospects of promotion including pay scale and allowances attached to the higher grades will be as per the provisions of IOFHS Rules 2001 and the orders and instructions issued by the Govt. from time to time.

(g)        Nature of Duties – (1) Assistant Medical Officers:-

(i)     They will attend to indoor patients in wards/departments of hospitals and out patients/dispensaries/out-patient departments daily and as required.

(ii) They will carry out medical examination of employees and candidates for employment in accordance with the regulation in force.

(iii) They will maintain the upkeep of equipments in their charge.

(iv) They will be responsible for training, discipline and proper discharge of duties of the hospital and dispensary staff.

(v) They will perform such other duties as are allotted to them by the Medical Officer-in-charge as per rules.

(2)            Assistant Director Health Services and Senior Medical Officer -

(a)       ADHS posted at the Hrs. will assist the DHS/Addl. DHS/DDHS in discharge of their duties on all medical matters as directed by them.

(b) He will assist the DHS/Addl. DHS/DDHS in the day to day work of the Medical Section as the Section Officer.

(c)        He will perform such other duties as may be assigned to him by the DHS/Addl.DHS/DDHS from time to time.

(d)       He will assist the DHS in dealing with all questions relating to Medical Stores and Equipments.

(e)       They will arrange medical attention to the employees and their families as per rules.

(f)         SMOs will attend indoor Wards, Factory Health Clinic Estate Clinic, OPD and will be required to perform such other duties and may be assigned by PMO and SMO incharge of the Hospital.

(3)       Dy. Director Health Services and Principal Medical Officer: -

(a)               DDHS posted at the Hqrs. will assist the DHS/Addl. DHS in the discharge of the latter’s duties in matters as directed by him.

(b)               PMO – Senior – PMOs will be M.O. incharge of factory, hospitals and the Medical Estt. there.

(c)               As M.O. Incharge they will be advisers to the GM of FYs. on all medical matters and make recommendation as considered necessary.

(d)               They will arrange medical attention to the employees and their families as per rules.

(e)               They will perform such other duties as may be laid down under any statute of Govt. orders or delegated to him by the DHS.

(f)                 Principal Medical Officers will attend indoor Wards. Factory Health Clinic, Estate Health Clinic OPD and will be required to perform such other duties as may be assigned by PMO-in-charge of the Hospital.

(4)            Additional director Health Services :-

(a)               Addl. DHS will assist the DHS in discharge of the latter’s duties in the matter as directed by him.

(b)               He will act as DHS under order of DGOF in latter’s absence on leave, tour etc.

(5)       Chief Medical Officer:-

(a)               He/She will have overall responsibility Administration of Ord. Fy. Hospitals having specialist centres, including Factory Health Organisation and Family Welfare Centre.

(b)               Advice General Manager on medical, health, hygiene and occupational health matters.

(c)               Plan, Organise and monitor the work of the medical establishment and review progress.

(d)               Organise hospital services in accordance with the orders, instructions and regulations issued from time to time by higher authorities.

(e)               Ascertain the expressed and implied needs and expectations, grievances and suggestions of patients, factory management, statutory authorities and community and organize the health services to meet them wherever possible.

(f)                 Ensure that all the resources allotted to the medical establishments are fully and optimally utilized and economy is observed in the functioning.

(g)               They will perform such other duties as may be laid down under any statute of Govt. orders or delegated to him by DHS.

(6)            Director Health Services: -

(a)               Medical adviser to DGOF on all medical and health matters. Controlling Authority of the Medical Establishment in DGOF organisation on all professional and Technical matters. He will exercise the administrative powers as delegated to him by the DGOF.

(b)               He will work out the plans for implementation of the reports/ recommendations accepted by the Govt. 

(c)               As the Controlling Authority he will distribute the personnel according to the requirement of factories.

(d)               He will normally represent the DGOF on the UPSC.

(e)               He will normally once a year make or cause to be made inspection of all factories and report to the DGOF on the working of Medical installation thereon all matters connected with Medical Estt.

(f)                 He will initiate ACR of Addl. DHS and will review the reports of all SA grade, JAG(NFSG) & JAG(OG) officers of IOFHS.

III            Junior Scale Posts in the Central Health Service:

(a)               The posts are temporary but likely to continue indefinitely, Candidates will be appointed to Junior Group `A’ scale and they will be on probation for a period of 2 years from the date of appointment which may be curtailed or extended at the discretion of the Competent Authority. They will be confirmed after the satisfactory completion of probation.

(b)               The candidates can be posted anywhere in India in any dispensary or hospital under any organisation participating in the Central Health Service viz. C.G.H.S. operating at Delhi, Banglore, Bombay,k Meerut etc. Lakshadweep, Andaman and Nicobar Islands. P & T Department etc. Private practise of any kind whatsoever including Lab. and consultant practice is prohibited.

(c)               The scale of pay admissible to the Medical Officer of CHS is Rs. 8,000 – 275 – 13,500. Other allowances like N.P.A., H.R.A. etc. and the promotional avenues will be available as per the provision of CHS Rules, 1996 and the orders and instructions issued by the Govt. from time to time.

IV            Medical Officer in the Municipal Corporation of Delhi.

(i)         The posts are temporary in Category `A’ but likely to be made permanent in due course. The scale of pay is Rs. 8,000 – 275 – 13,500 plus restricted no-practising allwance (NPA) as per orders in force from time to time.

(ii)        The candidate will be on probation for a period of one year from the date of appointment which may be curtailed or extended at the discretion of competent authority. On satisfactory completion of the probation period, he will continue in the temporary post till confirmed against the permanent vacancy.

(iii)       The candidate can be posted any where within the jurisdiction of the Municipal Corporation of Delhi in any one of the Hospitals/Dispensaries/M&CW and Family welfare Centres/Primary Health Centres etc.

(IV)            Private practice of any kind whatsoever is prohibited.

(V)       The appointment can be terminated on one month’s notice on either side during the period of probation and thereafter while employed in temporary capacity. The Municipal Corporation of Delhi reserve the right to pay one month’s pay in lieu of notice.

           Prospects of promotion including pay scales and allowances attached to the higher grades shall be according to the provision of the Recruitment regulations.

APPENDIX-III

REGULATIONS RELATING TO THE PHYSICAL/MEDICAL EXAMINATION OF CANDIDATES

          The regulations are published for the convenience of candidates and to enable them to ascertain the probability of their possessing the required physical standards. The regulations are also intended to provide guidelines to the medical examiners.   All posts to be filled on the basis of Combined Medical Services Examination are Group ‘A’ “Technical” posts.

2.         (a)            The Government of India reserve to themselves absolute discretion to reject or accept any candidate after considering the report of the Medical Board.

(b)            To be passed as “fit” for appointment, a candidate must be in good mental and bodily health and free from any physical defect likely to interfere with the efficient performance of the duties of his/her appointment.

           (c)            In the matter of co-relation of age limit, height, weight and chest girth of candidates of India (including Anglo-Indian race), it is left to the Medical Board to use whatever co-relation of figure is considered most suitable as a guide in the examination of the candidates. Trunk and limbs should be proportionate, no minimum height be insisted upon, if found fit otherwise.  If there be any disproportion with regard to height, weight and chest girth, the candidates should be hospitalized for investigation and X-Ray of the chest taken before the candidate is declared fit or unfit by the Board.

3.         The candidate’s height will be measured as follows:-

He/She will remove his/her shoes and be placed against the standard with his/her feet together and the weight thrown on the heels and not on the toe or other sides of the feet. He/She will stand erect without rigidity and with heels, calves, buttocks and shoulders touching the standard; the chin will be depressed to bring the vertex of the head level under the horizontal bar and the height will be recorded in centimeters and parts of a centimeter to halves.  

4.         The candidate’s chest will be measured as follows:-

           He/She will be made to stand erect with his/her feet together and to raise arms over his/her head. The tape will be so adjusted round the chest that its upper edge touches the inferior angles of the shoulder blades behind and lies in the same horizontal plane when the tape is taken round the chest. The arms will then be lowered to hang loosely by the side and care will be taken that the shoulders are not thrown upwards or backwards so as to displace the tape. The candidate will then be directed to take a deep inspiration several times and the maximum expansion of the chest will be carefully noted and the minimum and maximum will then be recorded in centimeters 84-89, 86-93.5 etc. In recording the measurements fractions of less than half a centimeter should not be noted.

N.B.- The height and chest of the candidates should be measured twice before coming to a final decision.

5.         The candidate will also be weighed and his/her weight recorded in Kilograms; fractions of half a kilogram should not be noted.

6.         (a)            The candidate’s eye-sight will be tested in accordance with the following rules. The result of each test will be recorded.

            (i)            General – The candidate’s eyes will be submitted to a general examination directed to the detection of any disease or abnormality. The candidate will be rejected if he suffers from any morbid conditions of eye(s), eyelids or contiguous structure of such a sort as to render or are likely to render him/her unfit for service on a future date.             

(ii)            Visual Acuity – The examination for determining the acuteness of visions includes two tests - one for distant and the other for near vision. Each eye will be examined separately.

          (b)            There shall be no limit for maximum naked eye vision but the naked eye vision of the candidates shall however be recorded by the Medical Board or other medical authority in every case, as it will furnish the basic information in regard to the condition of the eye.

          (c)            The following standards are prescribed for distant and near vision with or without glasses for different types of services.

Class of Service

 

	Indian Railway Medical Services (Technical)		Services other than IRMS (Technical)
	Better eye	Worse eye	Better eye (corrected vision)	Worse eye
1.  Distant Vision	With or without glasses upto     + 4D 6/9 or 6/6	With or without glasses upto     + 4D 6/9 or 6/12	6/6 or 6/9	6/12, 6/18 or Nil
2.  Near Vision	With or without glasses upto     + 4D J1	With or without glasses upto     + 4D J2	J1 J2	J2, J3 or Nil
3.  Type of correction permitted	Spectacles, IOL/corneal surgeries viz (LASIK, excimer surgeries etc.) may be permitted.  Vision should be stable and should come up to the required standard. Ophthalmic Board to clear fitness.		Spectacles, I0L, LASIK Laser surgery
4. Limits of refractive error permitted	+4.00 D In case where power of lens is      > - 4D, a special ophthalmic Medical Board to clear the case ruling out pathological myopia.		Fundus is normal and without pathological Myopia.
5. Colour vision requirements	Higher grade colour perception (Ishihara test EGL – 1.3 mm aperture)		Low Grade colour vision is acceptable
6.  Whether binocular vision needed?	Binocular vision is necessary in case of squint.  In deserving cases, a special Ophthalmic Medical Board to clear cases on case-to-case basis.		No

(d) (i)            In respect of the Technical Services mentioned above and any other service concerned with the safety of public, the total amount of Myopia (including the cylinder) shall not exceed - 4.00 D; total amount of Hypermetropia (including the cylinder) shall not exceed + 4.00  D.  

Provided that in case a candidate in respect of the “Technical” services other than the services under the Ministry of Railways is found unfit on ground of high myopia, the matter shall be referred a Special Board of three ophthalmologists to declare whether this myopia is pathological or not. In case it is not pathological, the candidate shall be declared fit, provided he/she fulfils the visual requirements otherwise. 

(ii)            In every case of myopia, fundus examination should be carried out and the results recorded. In the event of pathological condition being present which is likely to be progressive and affect the efficiency of the candidate, he/she should be declared unfit.

  (e)   Field of Vision: The field of vision shall be tested in respect of all services by the confrontation method. When such test gives unsatisfactory or doubtful result the field of vision should be determined on the perimeter.

(f)     Night Blindness: Broadly there two types of night blindness: (i) as a result of Vitamin a deficiency and (ii) as a result of Organic disease of Retina-common cause being Retinitis Pigmentosa. In (i) the fundus is normal, generally seen in younger age group and ill nourished persons and improves by large doses of Vitamin A. In (ii) the fundus is often involved and mere fundus examination will reveal the condition in majority of cases. The patient in this category is an adult and may not suffer from malnutrition. For both (i) and (ii) dark adaptation test will reveal the condition.

(g)   Colour Vision: The testing of colour vision shall be essential in respect of the Technical Services mentioned above.  

Colour perception should be graded into higher and lower grade depending upon the size of aperture in the lantern as described in the table below:- 

 

Grade		Higher Grade Colour Perception	Lower Grade Colour Perception
1		2	3
1.	Distance between the lamp and the candidate	16 ft.	16 ft.
2.	Size of aperture	1.3 mm.	13 mm.
3.	Time of exposure	5 seconds	5 seconds

   For Indian Railway Medical Service Higher Grade colour vision is essential but for other services lower grade colour vision will be considered sufficient.

              Satisfactory colour vision constitutes recognition with ease and without hesitation of signals red, green and yellow colours. The use of Ishihara’s plates, shown in good light and a suitable Edrige Green’s Lantern shall be considered quite dependable for testing colour vision. While either of the two tests may ordinarily be considered sufficient in respect of the services other than IRMS, it is essential to carry out the lantern test for IRMS. In doubtful cases where a candidate fails to qualify when tested by only one of the two tests, both the tests should be employed. However, both the Ishihara’s plates and Edrige Green’s lantern shall be used for testing colour vision of the candidates for appointment to the Indian Railway Medical Service.

(h)        Ocular condition other than visual acuity :-

(i) Any organic disease or a progressive refractive error, which is likely to result in lowering visual acuity, should be considered a disqualification.

(ii) Squint : For Indian Railway Medical Service where the presence of binocular vision is essential, squint, even if the vision acuity in each eye is of the prescribed standard, should be considered a disqualification. For other services the presence of squint should not be considered as a disqualification, if the visual acuity is of the prescribed standard. 

(iii) If a person has one eye or if he has one eye which has normal vision and the other eye is amblyopic or has subnormal vision the usual effect is that the person is lacking stereoscopic vision for perception of depth. Such vision is not a disqualification for services other than IRMS. The Medical Board may recommend as fit, such persons provided the normal eye has –

Ø      6/6 distant vision; J1 near vision with or without glasses provided the error in any meridian is not more than 4 dioptres for distant vision.

     Ø      full field of vision.

                              Ø      normal colour vision wherever required :

Provided the board is satisfied that the candidate can perform all functions for the particular job in question.

  (iv) Contact Lenses: During the Medical Examination of the candidates, the use of contact lenses is not to be allowed. It is necessary that when conducting eye tests the illumination of the typed letters for distant vision should have an illumination of 15 foot candles.

GUIDELINES FOR SPECIAL OPTHALMIC BOARD

Special ophthalmic Board for eye examination shall consist of 3 ophthalmologists:

(a)               Cases where the Medical Board has recorded visual function within normal prescribed limits but suspects a disease of progressive and organic nature which is likely to cause damage to the visual function should refer the candidates to a Special Ophthalmic Board for opinion as part of the first Medical Board.

(b)               All cases of any type of surgery on eyes, IOL, refractive corneal surgery, doubtful cases of colour defect should be referred to special ophthalmic board.

(c)               In such cases where a candidate is found to be having high myopia  or high hypermetropia the Central Standing Medical Board/State Medical Board should immediately refer the candidates for a Special Board of three Ophthalmologists constituted by the Medical Superintendent of the hospital with the Head of the Department of Ophthalmology of the Hospital or the Senior-most Ophthalmologist as the Chairman of the Special Ophthalmic Board. The Ophthalmologist/Medical Officer who has conducted the preliminary ophthalmic examination cannot be a part of the Special Board.

The examination by the Special Board should preferably be done on the same day. Whenever it is not possible to convene the Special Board of three Ophthalmologists on the day of the medical examination by the Central Standing Medical Board/State Medical Board, the Special Board may be convened at an earliest possible date.

The Special Ophthalmic Board may carry out detailed investigations before arriving at their decision.

The Medical Board’s report may not be deemed as complete unless it includes the report of the Special Medical Board for all such cases which are referred to it.

  GUIDELINE FOR REPORTING ON BORDER LINE UNFIT CASES

           In border line cases of substandard visual acuity, subnormal colour vision, the test will be repeated after 15 minutes by the Board before declaring a person unfit.

7.                              Blood Pressure:

The Board will use its discretion regarding Blood Pressure.  A rough method of calculating normal maximum systolic pressure is as follows :-

            (i)            with young subjects of 15 – 25 years of age, the average is about 100 plus the age.

            (ii)            with subjects over 25 years of age, the general rule of 110 plus half the age seems quite satisfactory.

            N.B. – As a general rule any systolic pressure over 140 mm. and diastolic over 90 mm. should be regarded as suspicious and the candidate should he hospitalised by the Board before giving their final opinion regarding the candidate’s fitness or otherwise.  The hospitalisation report should indicate whether the rise in blood pressure is of a transient nature due to excitement etc. or whether it is due to any organic disease.  In all such cases X-ray and electro-cardiographic examination of heart and blood urea clearance test should also be done as a routine.  The final decision as to fitness or otherwise of a candidate will, however, rest with the medical board only.

            Method of taking Blood Pressure

            The mercury manometer type of instrument should be used as a rule.  The measurement should not be taken within fifteen minutes of any exercise or excitement.  Provided the patient and particularly his/her arm is relaxed, he may be either lying or sitting and the arm is supported comfortably at the patient’s side in a more or less horizontal position.  The arm should be freed from the cloth to the shoulder.  The cuff completely deflated should be applied with the middle of the rubber over the inner side of the arm and its lower edge an inch or two above the bend of the elbow.  The following returns of cloth bandage should spread evenly over the bag to avoid bulging during inflation.

            The brachial artery is located by palpitation at the bend of the elbow and the stethoscope is then applied lightly and centrally over it below but not in contact with the cuff.  The cuff is inflated to about 200 mm. Hg. and then slowly deflated.  The level at which the column stands when soft successive sounds are heard represents the Systolic Pressure.  When more air is allowed to escape the sound will be heard to increase in intensity.  The level at which the well-heard clear sounds change to soft muffed fading sounds represents the diastolic pressure.  The measurements should be taken in a fairly brief period of time as prolonged pressure of the cuff is irritating to the patient and will vitiate the reading.  Rechecking if necessary should be done only a few minutes after complete deflation of the cuff.  Sometimes as the cuff is deflated sounds heard at a certain level may disappear as pressure falls and reappear at a still lower level.  This/her silent gap may cause error in readings.

            8.            The urine (passed in the presence of the examiner) should be examined and the results recorded.  Where a Medical Board finds sugar present in candidate’s urine by the usual chemical tests, the Board will proceed with the examination with all its other aspects and will also specially note down any signs or symptoms suggestive of diabetes.  If except for the glycosuria the Board finds the candidate conforms to the standard of medical fitness required they may pass the candidate as fit, subject to the glycosuria being non-diabetic and the Board will refer the case to a specified Specialist in Medicine who has hospital and laboratory