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关于同志近三年现实表现材料材料类招标技术评分表图表与交易pdf视力表打印pdf用图表说话 pdf
FOREIGNERPHYSICALEXAMINATIONFORM姓名性别□男Male出生日期照片NameSex□女FemaleBirthday(加盖检查单位印章)现在通讯地址PresentmailingaddressPhoto(StampedOfficial国籍或地区出生地血型Stamp)NationalityBirthBloodtype(orArea)place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”)班疹伤寒Typhusfever□No□Yes菌痢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Puerperalstreptococcusinfection回归热Relapsingfever□No□Yes菌感染□No□Yes伤寒和付伤寒Typhoidandparatyphoidfever□No□Yes流行性脑脊髓膜炎Epidemiccerebrospinalmeningitis□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”)Doyouhaveanyofthefollowingdiseasesordisordersendangeringthepublicorderandsecurity?(Eachitemmustbeanswered“Yes”or“No”)毒物瘾Toxicomania…………………………………………………□No□Yes精神错乱Mentalconfusion……………………………………………□No□Yes精神病Psychosis：躁狂型Manicpaychosis…………………………………□No□Yes妄想型Paranoidpsychosis………………………………□No□Yes幻觉型Hallucinatory……………………………………□No□Yes身高厘米体重公斤血压毫米汞柱HeightCMWeightKgBloodpressuremmHg发育情况营养情况颈部DevelopmentNourishmentNeck视力左L矫正视力左L眼Vision右RCorrectedvision右REyes辨色力皮肤淋巴结ColoursenseSkinLymphnodes耳鼻扁桃体EarsNoseTonsils心肺腹部HeartLungsAbdomen四肢神经系统脊柱ExtremitiesNervoussystemSpine其他所见Otherabnormalfindings心电图胸部X线ECC检查结果(附检查
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单)ChestX-rayexam(attachedchestX-rayreport)化验室检查(包括艾滋病、梅毒等血清学检查)Laboratoryexam(attachedtestreportofAIDS,Syphilisetc)未发现患有下列检疫传染病和危害公共健康的疾病:Noneofthefollowingdiseasesofdisordersfoundduringthepresentexamination.霍乱Cholera性病VenerealDisease黄热病Yellowfever肺结核Lungtuberculosis鼠疫Plague艾滋病AIDS麻风Leprosy精神病Psychosis意见检查单位盖章SuggestionOfficialStamp医师签字日期SignatureofphysicianDate
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