Transcription of PHYSICAL EXAMINATION RECORD FOR FOREIGNER
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PHYSICAL EXAMINATION RECORD FOR FOREIGNER
PHYSICAL EXAMINATION RECORD FOR FOREIGNER . Male . Name Sex Female Birth day . present mailing address Photo Blood type Nationality Birth place . Have you ever had any of rhe following diseases? Typhus fever No Yes Bacillarydysentery No Yes Poliomyelitis No Yes Brucellosis No Yes Diphtheria No Yes Viral hepatitis No Yes Scarlet fever No Yes puerperal streptococcus infection Relapsing fever No Yes No Yes Typhoid & paratyphoid fever No Yes Epidemic cerebrospinal meningitis No Yes . Do you have any of the following diseases or disorders endangering the public order and security? Toxicomamia No Yes Mental confusion No Yes Psychosis Manic psychosis No Yes Paranoid psychosis No Yes Hallucinatory psychosis No Yes . Height cm Weight Kg Blood Pressure mmHg . Development Nourishment Neck L L . Vision R Corrected vision R Eyes . Colour sense Skin Lymph nodes.
外国人体格检查记录 PHYSICAL EXAMINATION RECORD FOR FOREIGNER 姓名 Name 性别 Sex 男 Male 女 Female 出生日期 Birth day
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