外国人体格检查记录.doc.docVIP

外国人体格检查记录 PHYSICAL EXAMINATION RECORD FOR FOREIGNER * Please turn over the form End of the form 脊柱Spine 四肢Extremities 神经系统Nervous system 其他所见other abnormal findings 胸部X 线检查chest X-ray exam 心电图ECG 化验室检查包括血清学诊断Laboratory exam Serodiagnosis 未发现患有下列检疫传染病和危害公共健康的疾病None of the following diseases or disorders found during the present examination 霍乱Cholera 性病venereal disease 黄热病Yellowfever 开放性肺结核Openning lung Tuberculosis 鼠疫Plague 爱滋病AIDS 麻风leprosy 精神病Psychosis 意见Suggestionj 检查单位盖章Official Stamp 医师意见Signature of physician 日期Date