1、外國人體格檢查記錄physical examination record for foreigner體檢說明explanation of the physical examination1. 在華工作或學習六個月以上的外國人，應按照“外國人體格檢查記錄"進行體格檢查。體檢表貼 照片處，應有醫院卬章，否則，視體檢表無效。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,

2、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. 體檢表應填寫清楚，體檢報告應附有x光透視胸片及霍亂、黃熱、鼠疫、麻風、性病、開放性 肺結核、艾滋病、肝功能、澳抗和精神病的化驗室檢查報告。ii all the items of this form should be filled in

3、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

4、 function and hb&ag.3. 體檢應在來華一個月前在公立醫院進行，凡在私立醫院體檢者，應取得公證部門的公證。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. 體檢表是辦理入境簽證及在華居留手續所需文件之

5、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.外國人體格檢查表foreigner physical examination form姓名name性別sex男 male 女 female出生日期birth day 一 mo

6、nth year照片 （加蓋檢查 單位印章）現在通信地址present mailing address血型 blood type國籍或地區 nationality (or area)出生地址 birth placephoto (stamped official stamp)過去是否患有下列疾病：（每項后面請回答“否”或“是”）have you ever had any of the following diseases?(each item mustbe answered "yes" or “no”)斑疹傷寒typhus fever nodyes菌痢bacillary dy

7、senterynodyes小兒麻痹癥poliomyelitisnodyes布氏桿菌病brucellosisnodyes白喉diphtherianodyes病毒性肝炎viral hepatitismoejyes猩紅熱scarlet fevernodyes產褥期鏈球pueiperal streptococcus infection回歸熱relapsing fever nodyes菌感染nodyes傷寒和付傷寒 typhoid and paratyphoid fevernoejyes流行性腦脊髓膜炎 epidemic cerebrospinal meningitisnodyes是否患有下列危機公共秩

8、序和安全的病癥：(每項后面請回答“否”或“是”) do you have any of the following diseases or disorders endangering the public order and security?(each item must be answered "yes" of "no")毒物癮toxicmania dnoliyes精神錯舌l metal confusion nnodyes精神病psychosis：躁狂型manic psychosis cnocyes妄想型paranoid psychosis noej

9、yes幻想型hallucinatory psychosis elnoliyes身高height厘米cm體重weight公斤kg血壓blood pressure毫米汞柱mmhg發育情況營養情況頸部developmentnourishmentneck視力左l矯正視力左l眼vision右rcorrected vision右reyes辨色力皮膚淋巴結color sensesskinlymph nodes耳鼻扁桃體earsnosetonsils心肺腹部heartlungsabdome n脊柱四肢神經系統spineextremitiesnervous system其它所見other abnormal fi

10、ndings胸部x線 檢查結果 (附檢查報告單) chest x-ray exam (attached chest x-ray report)心電圖ecg化驗室檢查 (包括艾滋病、梅 毒等血清學檢查) laboratory exam (attached test report of aids, syphilis etc)未發現患有下列檢疫傳染病和危害公共健康的疾病：none of the following diseases of disorders found during the prese nt exami nation. 霍舌lcholera性務venereal disease黃熱病y

11、ellow fever肺結核lung tuberculosis鼠疫plague艾滋病aids麻風leprosy精神病psychosis意見檢查單位蓋章suggestionofficial stamp醫師簽字日期signature of physiciandatethe foreigners are supposed to take the physical exami nation before leaving in a national or regional public hospital and get report of all the items listed in the form

12、 with the signature of the doctor and the stamp of the hospital. if the check is done in a private hospital or clinic, the report should be notarized by a public notary. the form submitted should be the original copy with the photo of the examinee and supporting documentations such as laboratory rep

13、ort sheets, x-ray films and necessary testing reportsthe administration of quality supervision, inspection and quarantine will double check the submitted form and attached documentations upon their arrival and decide whether ifs acceptable or they should take additional or another physical exami nat