文档介绍：男性婚前医学检查表填写日期:  年  月  日                                                近期一寸姓名:                       出生日期:  年  月   日                 免冠正面身份证号:□□□□□□□□□□□□□□□□□□›››  照片加盖婚检专用章职业:             文化程度:             民族                户口所在地属          省         市       区(县)       街道(乡)现住址:                                              邮编:››››››工作单位:                                            联系电话:                  对方姓名:                 以--下--由--医—生--填--写编   号:                   对方编号:              检查日期:  年   月   日血缘关系:无 表 堂 其他                                                         既往病史:无 心脏病 肺结核 肝脏病 泌尿生殖系疾病 糖尿病 高血压 精神病 性病癫痫 甲亢 腮腺炎 先天疾患                                     手术史:无 有                  其他:                                现病史:无 有                                                                    既往婚育史:无 有(丧偶,离异)  子、女       人                            与遗传有关的家族史:无 盲 聋 哑 精神病 先天性智力低下 先天性心脏病  血友病糖尿病 其他                               患者与本人关系                家族近亲婚配: 无     有(父母 祖父母 外祖父母)                                                                          受检者签名          医师签名            体格检查血压:      /        mmHg                特殊体态:无   有                       精神状态:正常 异常                       特殊面容:无   有                        智力:正常 异常(常识、判断、记忆、计算) 皮肤毛发:正常 异常                      五   官:正常 异常                       甲状腺:正常 异常                     心:心率       次/分 心律                杂音:无 有