体检表英文模版翻译英文版.doc

文档介绍：Physical Examination Record of XX Township
Name:
XX
Sex
Male
Date of birth:
Jul. 8, 1992
ID No.:
XXXX
Medical certificate NO.:
Servicing unit
XX
Telephone
XX
Please provide truthful medical history. The patient himself or herself shall bear any liabilities caused by concealing the facts. (Tick V after each item.).
Mental disorder Yes No V Epileptic disease Yes No V
Hysteria Yes No V Serious neurosis Yes No V
Drug smoking and Yes No V Serious heart attack, Yes No V
injecting history cardiomyopathy
Chronic nephritis Yes No V Uremia Yes No V
Infectious disease Yes No V Nerve system disease Yes No V
affecting limb exercise
Medical department
Blood pressure
120/75mmHg
Heart
Normal
Physician advice:
Signature:
Respiratory system
Normal
ans
Normal
Nerve system
others
Surgical
department
Height
180cm
Weight
77kg
Physic