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OutsideCountryPeopleandHong KongAoTaiwancellsbodygridCheckCheckRememberRecord
Physical Examination record Sky Bet app for Foreigner and Hongkong macao Taiwan Compatriot
Surname name name | Gender SEX | □ MaleMale □ GirlFemale | Date of birth\ BIRTH Day-Month-year | Photo Film (Covering inspection Unit seal) Photo (Stamped Office Stamp) | ||||||||||||||
Now communication address Present Mailing Address | Blood type blood Type | |||||||||||||||||
Country Nationality Nationality | birth address BIRTH PLACE | |||||||||||||||||
Whether to suffer from the following diseases in the past: (Please answer "Sky Bet app " or "Yes") Have You Ever Had Any of the Following Sky Bet app ? (Each item must be antswered "yes" or "Sky Bet app " SpotsrashTreatment of typhoid fever Typhus Fever □√Sky Bet app □Sky Bet app bacteria Diabang Bacillary DySensery □√Sky Bet app □Sky Bet app PuThe paralysis Poliomyelitis □√Sky Bet app □Sky Bet app Bacteria disease BRUCELLOSIS □√Sky Bet app □Sky Bet app White throat Diphtheria □√Sky Bet app □Sky Bet app viral hepatitis Viral Hepatitis □√Sky Bet app □Sky Bet app Gorilla Red Hot Scarlet Fever □√Sky Bet app □Sky Bet app Chain ball during puerperium Puerperal Streptococcus Information Back Return Hot Relapsing Fever □√Sky Bet app □Sky Bet app bacteria Feel Dye □√Sky Bet app □Sky Bet app Treatment of Typhoid and Pic. Typhoid and Paraatyphoid Fever □√Sky Bet app □Sky Bet app Popularic cerebral grsoneitis Epidemic Cerebrospinal Meningitis □√Sky Bet app □Sky Bet app | ||||||||||||||||||
Do you have the following diseases that endanger public order and security: (Please answer "Sky Bet app " or "Yes") Do you have any of the Sky Bet app illases or DISORDERS ENGERING The Pubic Order and Security? (Each item must be angred "yes" or "Sky Bet app ") PoisonobjectAddiction Toxicomania………………………………………………………………………………√Sky Bet app □Sky Bet app Nervous disorder Mental Confusion………………………………………………………………………√Sky Bet app □Sky Bet app GodScripturesDisease psychosis: Right -typeManic psychosis…………………………………………………………√Sky Bet app □Sky Bet app delusional typeParanoid psychosis…………………………………………………… □√Sky Bet app □Sky Bet app Fantasy typeHallucinate psychosis……………………………………………… □√Sky Bet app □Sky Bet app | ||||||||||||||||||
Height cm Height cm | Weight kg Weight kg | Blood pressure Knipa blood Pressure KPA | ||||||||||||||||
Development Development | Nutrition Nourishment | Cervical Next | ||||||||||||||||
visionLeftL Vision RightR | Correct vision LeftL Correct Vision RightR | Eye Eyes | ||||||||||||||||
color discerning force Colour Sense | Skin Skin | lymph nodes lymph nodes | ||||||||||||||||
Ear Ears | Nose Nose | tonsil tonsils | ||||||||||||||||
Heart Heart | Lung LUNGS | Abdomen Abdomen | ||||||||||||||||
Spine Pillar spine | 4 limbs Extremities | nervous system Nervous System | ||||||||||||||||
Other see Other Abnormal Findings | ||||||||||||||||||
chestDepartmentX Line CheckCheckknotFruit (Affiliated Report Elberry) Chest x-ray Exam (Attached Chest x-ray Report | ECG ECG | |||||||||||||||||
HuatestRoomCheckCheck (includingHIVantibodies, syphilis and other serum examination, Attach the original inspection report form) Laboratory Exam (Attached Test Report of Aids, Syphilis ETC) | Hepatitis C antibody/anti-HCV: Alanine base metastases/GPT:(& lt; 29U/L) Syphilis confirmation test/TPPA: AIDS virus antibody/anti-HIV: | |||||||||||||||||
Sky Bet app diseases with the following quarantine infectious diseases and diseases that endanger public health: None of the Following Sky Bet app or Disorders Found During the Present ExaminationHuo Chaos chlolera sex Disease Venereal Disease Yellow fever Yellow Fever Tuberculosis lung tuberculosis Rat Epidemic Plague AIDS AIDS Ma Wind leprosy mental illness psychosis | ||||||||||||||||||
Italia see Checking unit stamp Suggestion Sky Bet app abnormal discovery. Office Stamp Signature of the doctor Date year month Day Signature of Physician Date | ||||||||||||||||||
Sky Bet app download:Foreign Sky Bet app human body inspection table.doc