外国人体格检查记录

《外国人体格检查记录》由会员上传分享，免费在线阅读，更多相关内容在学术论文-天天文库。

1、外国人体格检查记录PHYSICALEXAMINATIONRECORDFORFOREIGNER姓名Name性别□男MaleSex□女Female出生月年BirthDayMonthYear照片photo现在通讯地址Presentmailingaddress血型BloodType国籍Nationality出生地BirthPlace过去是否患有下列疾病：（每项后面请回答“否”或“是”）Haveyoueverhadanyofthefollowingdiseases?(Eachitemmustbeanswered“Yes”or“No”)斑疹伤寒Typhusfever□No□Ye

2、s细菌性痢疾Bacillarydysentery□No□Yes小儿麻痹症Poliomyelitis□No□Yes布氏杆菌病Brucellosis□No□Yes白喉Diphtheria□No□Yes病毒性肝炎Viralhepatitis□No□Yes猩红热Scarletfever□No□Yes产褥期链球菌Puerperalstreptococcus□NO□Yes回归热Relapsingfever□No□Yes感染infection□No□Yes伤寒和副伤寒Typhoidandparatyphoidfever□No□Yes流行性脑脊髓膜炎Epidemiccerebros

3、pinalmeningitis□No□Yes是否患有下列危及公共秩序和安全的病症：（每项后面请回答：“否”或“是”）Doyouhaveanyofthefollowingdiseasesordisordersendangeringthepublicorderandsecure?(Eachitemmostbeanswered“Yes”or“No”)毒物瘾Toxicomania………………………………………………………………………………□No□Yes精神错乱Mentalconfusion………………………………………………………………………□No□Yes精神病Psycho

4、sis：躁狂型Manicpsychosis……………………………………………………□No□Yes妄想型Paranoidpsychosis…………………………………………………□No□Yes幻觉型Hallucinatorypsychosis……………………………………………□No□Yes身高/Height(厘米/cm)体重/Weight(公斤/kg)血压/pressureBlood(毫米汞柱/mmHg)发育情况Development营养情况Nourishment颈部Neck视力Vision左L右R矫正视力Correctedvision左L右R眼Eyes辨色力/Colo

5、rsense皮肤/Skin淋巴结/Lymphnodes耳/Ears鼻/Nose扁桃体/Tonsils心/Heart肺/Lungs腹部/Abdomen编号：42（19×27cm）脊柱/Spine四肢/Extremities神经系统/Nervoussystem其他所见/Otherabnormalfindings胸部X线检查/ChestX-rayexam心电图/ECG化验室检查(包括艾滋病、梅毒血清学诊断)/LaboratoryExam(HIV,SyphilisSerodiagnosis)未发现患有下列检疫传染病和危害公共健康的疾病：Noneofthefollowingd

6、iseasesordisordersfoundduringthepresentexamination.霍乱Cholera性病VenerealDisease黄热病Yellowfever开放性肺结核Openinglungtuberculosis鼠疫Plague艾滋病AIDS麻风Leprosy精神病Psychosis意见Suggestion检查单位盖章OfficialStamp医师签字日期SignatureofphysicianDate编号：42（19×27cm）体检说明EXPLANATIONOFTHEPHYSICALEXAMINATION1．在华学习六个月以上的外国留学

7、生，应按照“外国人体格检查记录”进行体格检查。体检表贴照片处，应有医院印章，否则，视体检表无效。Theforeignstudents,whointendtostudyinChinafor6monthsofmore,shouldgothroughaphysicalcheck-upbeforetheycometoChina,accordingtotherequirementsofPhysicalExaminationRecordforForeigners.ThehospitalsealshouldbeputacrossthephotoontheExamination