外国人体格检查表FOREIGNERPHYSICALEXAMINATIONFORM.docVIP

外国人体格检查记录 PHYSICAL EXAMINATION RECORD FOR FOREIGNER 体检 说 明 EXPLANATION OF THE PHYSICAL EXAMINATION 1．在华工作或学习六个月以上的外国人，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。 Ⅰ．Foreigners,, who intend to work or study in China for over 6 months, should go through a physical check-up before they come to China, according to the requirements of Physical Examination Record for Foreigners. The hospital seal should be put across the photo on the Examination Record, or the Record is invalid. 2．体检表应填写清楚，体检报告应附有X光透视胸片及霍乱、黄热、鼠疫、麻风、性病、开放性肺结核、艾滋病、肝功能、澳抗和精神病的化验室检查报告。 Ⅱ．All the items of this form should be filled in carefully and clearly. The report should be attached with the negative film for Chest X-ray exams, and the examination certificates for laborstory exams (Serodiagnosis), which include exams on Cholera, Yellow fever, Plague, Leprosy, Venereal Disease, Opening lung tuberculosis, AIDS, Psychosis, Liver function and HBAG. 3.体检应在来华一个月前在公立医院进行，凡在私立医院体检者，应取得公证部门的公证。 Ⅲ.The physical examination should be taken in the public hospitals one month before their departure, If the physical check-up is done at a private hospital, the student should get the certificate notarized. 4.体检表是办理入境签证及在华居留手续所需文件之一。 Ⅳ.The Physical Examination Form is one of the documents that is needed in the process of going through the visa formalities. The students should bring the original copy along with them when they come to China. – Month - Year 照 片 (加盖检查 单位印章) Photo (stamped Official stamp) 现在通信地址 Present mailing address 血型 Blood type 国籍或地区 Nationality (or Area) 出生地址 Birth Place 过去是否患有下列疾病：（每项后面请回答“否”或“是”） Have you ever had any of the following diseases? (Each item must be answered “Yes” or “No”) 斑 疹 伤 寒 Typhus fever □No□Yes 菌 痢 Bacillary dysentery □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 Viral hepatitis □No□Yes 猩 红 热 Scarlet fever □No□Yes 产褥期链球 Puerperal streptococcus infection