健 康 体 检 表(国外英文资料).docVIP

健 康 体 检 表(国外英文资料) Health check-up table Name: no. - - - - - Physical examination date Date of the year Responsibility for the doctor content Check item disease shape 1 asymptomatic chest 2 headache dizziness palpitations 4 5 6 7 8 chronic cough and expectoration 9 difficulty breathing chest pain more than 10 drink urine 11 12 13 fatigue weight loss 14 joint swelling 15 blurred vision 16 17 18 urination urgency hands and feet numbness Constipation 20 diarrhea 21 nausea vomiting 22 dazzling 23 ears to the chest distended 25 others / its/is/is/is/is/is/is/is/is a a shape Besides, The body temperature ℃ The pulse rate Times/min Breathing rate Times/min Blood pressure / mmHg The body is high The cm Body weight kg Waist circumference The cm Nutritional status raw live party type Physical exercise Exercise frequency Once a day, 2 times a day, 3 times a week, 4 do not exercise - Time of exercise minutes Exercise time years exercise Eating habits One meatless equilibrium 2 meat food, 3 vegetarian, 4 basophil and 6 sugar / / / / / Smoking status Smoking status 1 never smoke 2 quit smoking 3 smoking - Smoking, Average branch Start smoking age At the age of Quit smoking age At the age of drinking Drinking frequency 1 never 2 occasionally 3 often 4 days - Daily drinking Mean two Whether to give up drinking No alcohol, no, no, no, no, no, no, no, no - Drinking age At the age of Have you been drunk for nearly a year 1 is 2 n - Types of drinking 1 liquor 2 beers 3 red wine 4 yellow wine 5 others / / / Occupational exposures situation No 2 has (a specific career year) There are no two chemical protection measures for poisons The poisons protection measures 1 no 2 Ray protection measures 1 without 2 - - - - dirty device work can The mouth cavity Lips 1 red and 2 pale 3 hair dry 4 chaps 5 herpes Tooth column 1 normal 2 deficient teeth 3 decayed teeth (false teeth) Pharynx 1 no congestive 2 congestive 3 lymphocytic hyperplasia - - - Depending on the force Left eye (right eye vision co