英文健康体检表 CERTIFICATE OF HEALTH
英语体检报告范本
英语体检报告范本Physical Examination ReportName: [Insert Name]Date of Birth: [Insert Date of Birth]Gender: [Insert Gender]Nationality: [Insert Nationality]Date of Examination: [Insert Date of Examination]1. Vital Signs:- Blood Pressure (BP): [Insert BP]- Heart Rate (HR): [Insert HR]- Respiratory Rate (RR): [Insert RR]- Body Temperature (BT): [Insert BT]2. General Appearance:The patient appears to be in good health and maintains normal body posture. No signs of distress or discomfort are observed.3. Head and Neck:- Head: The patient's head is normocephalic without any visible abnormalities.- Eyes: The patient's eyes show normal conjunctiva and sclera, and the pupils are equal in size and responsive to light.- Ears: The external ears are symmetrical and without any signs of inflammation or discharge.- Nose: The nose is symmetrical, and there is no nasal discharge or deformity.- Throat: No redness, swelling, or tonsillar enlargement is observed in the throat.4. Respiratory System:- Lung Sounds: Clear breath sounds are auscultated bilaterally on inhalation and exhalation.- Respiratory Effort: Breathing is regular, and the patient shows no signs of difficulty or increased effort.- Cough: No productive or non-productive cough is reported by the patient.5. Cardiovascular System:- Heart Sounds: S1 and S2 heart sounds are normal and regular without any extra sounds or murmurs.- Peripheral Pulses: Radial and pedal pulses are strong and palpable bilaterally.- Edema: No edema is observed in the extremities.6. Gastrointestinal System:- Abdomen: The abdomen is soft and non-tender upon palpation. No organomegaly or masses are detected.- Bowel Movements: The patient reports having regular bowel movements without any difficulty or abnormality.7. Genitourinary System:- Urinary Function: The patient reports normal urinary frequency and without any pain or discomfort during urination.- Genitalia: No abnormalities or signs of inflammation are observed.8. Musculoskeletal System:- Range of Motion: The patient demonstrates full range of motion in all major joints without pain or limitations.- Muscle Strength: Equal and symmetric muscle strength is observed in major muscle groups.9. Neurological System:- Mental Status: The patient appears alert and oriented to time, place, and person.- Cranial Nerves: All cranial nerves are intact and functioning properly.- Reflexes: Deep tendon reflexes are normal and symmetric in all extremities.10. Skin:- Skin Integrity: The skin is intact with no evidence of lesions, rashes, or discoloration.- Hygiene: The patient maintains good personal hygiene.Conclusion:Based on the physical examination, the patient's overall health appears to be in excellent condition. No significant abnormalities or concerns are noted. These findings are based solely on the physical examination conducted on the specified date and should be interpreted in conjunction with the patient's medical history. Additional diagnostic tests may be required for a comprehensive evaluation if deemed necessary.Note: This is a sample physical examination report and should not be used as an official medical document. Personal information and results should be modified to reflect individual cases.。
健康诊断书
健康診断書CERTIFICATE OF HEALTH (to be completed by the examining physician)日本語又は英語により明瞭に記載すること。
Please fill out (PRINT/TYPE) in Japanese or English.氏名□男Male 生年月日年齢Name: , □女Female Date of Birth:Age: Family name, First name Middle name１．身体検査Physical Examination(1) 身長体重Height cm Weight kg(2) 血圧血液型脈拍□整regular Blood pressure mm/Hg～mm/Hg Pulse□不整irregular(3) 視力Eyesight: (R) (L)(R) (L)色覚異常の有無□正常normal 裸眼Without glasses矯正With glasses or contact lenses Color blindness □異常impaired(4) 聴力□正常normal 言語□正常normalHearing: □低下impaired Speech: □異常impaired２．申請者の胸部について，聴診とＸ線検査の結果を記入してください。
Ｘ線検査の日付も記入すること（６ヶ月以上前の検査は無効｡) Please describe the results of physical and X-ray examinations of the applicant's chest x-rays (X-rays taken more than 6 months priorto this certification are NOT valid).肺□正常normal 心臓□正常normalLungs:□異常impaired Cardiomegaly: □異常impaired↓←Date 異常がある場合Film No. 心電図Electrocardiograph :□正常normal□異常impaired Describe the condition of applicant's lungs.３．現在治療中の病気□Yes (Conditions/particulars: ) Under medical treatment at present □No４．既往症Past history : Please indicate with ＋or －and fill in the date of recoveryTuberculosis......□( . . ) Malaria.......□( . . ) Other communicable disease......□( . . )Epilepsy......□( . . ) Kidney disease.....□( . . ) Heart disease......□( . . )Diabetes......□( . . ) Drug allergy......□( . . ) Psychosis.....□( . . )Functional disorder in extremities......□( . . )５．検査Laboratory tests検尿Urinalysis: glucose ( ), protein ( ), occult blood ( )赤沈ESR:mm/Hr, WBC count:/cmm 貧血□anemiaHemoglobin:gm/dl, GPT:６．志願者の既往歴，診察・検査の結果から判断して，現在の健康の状況は充分に留学に耐えうるものと思われますか？Yes又はNoにチェックをしてください。
英文健康体检表 CERTIFICATE OF HEALTH
健康診断書CERTIFICATE OF HEALTHPlease fill out (PRINT/TYPE) in Japanese or English.氏名生年月日□男Male Name： , Date of Birth: ／／□女Female Family name First name , Middle nameApplicant健康診断の前に下記の質問に答えてください。
Please answer the questions below before submitting to a physician for your physical examination.1. 過去5年間に以下の病気あるいは大きな病気にかかったことがあれば記入してください。
Please check the list of diseases below and/or specify if you have had in the past five years.□ぜんそくAsthma □結核Tuberculosis □マラリアMalaria □てんかん Epilepsy □糖尿病 Diabetes □心臓病Heart Disease □腎臓病 Kidney Disease □肝臓病 Liver Disease □精神疾患 Psychosis□その他Other（）2.薬、食べ物、動物、その他でアレルギーがありますか。
はいいいえDo you have any allergies to drugs ,foods, animals and other? Yes ／No具体的に記入してください。
Please specify.( )3.現在、何かの病気で薬を常用していますか。
はいいいえAre you taking medication now? Yes ／ No 病名Disease 服用薬 medication( ) （）Physician1. 身体検査Physical Examination身長体重血液型 RH ＋Height cm Weight kg Blood Type － A B O AB血圧Blood Pressure mm/Hg ～mm/Hg視力Eyesight (R) (L) (R) (L) 色覚異常の有無□正常normal 裸眼without glasses 矯正 with glasses or contact lenses color blindness □異常 impaired聴力□正常 normalHearing □低下 impaired2. 申請者の胸部について、聴診とX線検査の結果を記入してください。
体检证明英语作文模板
体检证明英语作文模板Title: Medical Examination Report English Composition Template。
---。
Introduction。
A medical examination report is a crucial document that provides a detailed overview of an individual's health status based on a series of tests and assessments. This report serves as an important tool for evaluating one's overall well-being and identifying potential health issues. In this essay, we will explore the significance of a medical examination report and discuss its components in detail.Body。
1. Purpose of a Medical Examination Report。
The primary purpose of a medical examination report is to assess and record an individual's health condition comprehensively. This report is typically requested by employers, educational institutions, or for immigration purposes to ensure that individuals meet certain health criteria.2. Components of the Report。
韩国签证肺结核健康诊断书样式
The examination was performed as above.
执照号码(License No.):
/ 医生姓名(Name of Physician):
(签章)
检查结果 (Summary of the examination)
对受检者停留的意见 (Remarks about examinee’s domestic stay)
【附件】
健康诊断书 Certificate of Health
姓名(Name) 出生日期(Date of Birth) 护照号码(Passport Number)
性别(Sex) □ M(男) □ F(女) 电话号码(Phone Number)
地址(Address)
照片 (Photo) 3㎝×4㎝
※钢印或骑缝章
4.血液检查 □
II. 治疗结果(2) (Treatment Outcomes) - For person who has TB history 治疗中(Under treatment) □ 治愈(Cured) □ 治疗完成(Completed Treatment) □ 治疗失败(Failed) □ 治疗中段(Defaulted) □
身高(Height)
检查内容 Physical examination and Chest X-ray
体重(Weight)
cm
Kg
血压 Pressure)
(Blood
/ mmHg
检查日(Date of Chest) / /
1.胸部X线检查 □ 2.痰结核菌检查 □ 3.结核菌素试验 □
I. 结果(1) (Result): 非特异所见(Non-specific) □ 非活动性结核(Inactive TB) ห้องสมุดไป่ตู้ 活动性结核 (Active TB) □ → 3-1. 传染性(Infective) □, 非传染性(Non-infective) □ → 3-2. 敏感性结核(Drug-sensitive TB) □,耐多药结核(MDR TB)
外国人体格检查表【模板】
Signature of physician Date
The foreigners are supposed to take the physical examinationbeforeleavingforChinain a national orregional public hospitaland get report of all the items listed in the form with thesignature of the doctor and the stampof the hospital. Theform submitted should be the original copy with the photo of the examinee andsupporting documentations such as laboratory report sheets, X-ray films and necessary testing reports.
猩红热Scarlet fever□No□Yes 产褥期链球Puerperal streptococcus infection
回归热Relapsing fever□No□Yes 菌 感 染□No□Yes
伤寒和付伤寒Typhoid andparatyphoidfever□No□Yes
流行性脑脊髓膜炎Epidemic cerebrospinal meningitis□No□Yes
妄想型Paranoid psychosis………………………………………□No□Yes
幻想型Hallucinatorypsychosis……………………………………□No□Yes
身高厘米
Height CM
体重公斤
身体检查报告英文
the health examination report date:篇二：检验报告常用英文汇总【简要介绍】除了上次介绍的血常规检查以外，血生化也是一项很常见的化验检查项目。
cmp是相对于bmp（basic metabolic panel）而言的。
bmp俗称“小生化”，或“基本生化”。
bmp包括8项“核心”生化检查。
cmp则在bmp所检查的8项核心内容的基础上，又添加了6项检查，共14项，因此称为“生化全项”。
另外，在一些国家和地区，除了cmp中的14项检查外，更进一步添加另外6项内容，合称“血生化20项”，英文简写为sma-20，或smac-20，或chem 20等。
【检查项目】本文主要介绍生化20项中除了血胆固醇外的19项内容，并另外加上一项“血镁”。
有关血胆固醇的信息将在以后的“血脂”检查中进一步讨论。
主要项目有：1。
bmp。
包括5项基本电解质：钠（sodium,，na），钾（ potassium，k），氯（chloride,，cl），碳酸氢离子（bicarbonate，hco3），以及钙（calcium ca）。
2项肾功能检查：肌酐（creatinine），及尿素氮（blood urea nitrogen，bun）。
再加1项血糖（glucose）。
2。
cmp中另外6项。
包括2项蛋白指标：总蛋白（total protein，tp）及白蛋白（albumin）。
和4项肝功能检查：碱性磷酸酶（alkaline phosphatase，alp），谷丙转氨酶（alanine aminotransferase，alt/sgpt），谷草转氨酶（aspartate amino transferase，alt/sgot），和胆红素（bilirubin）。
3。
sma-20（或chem 20）中多出来的6项。
包括3项肝功能检查：直接胆红素（directbilirubin），谷酰转肽酶（gamma-glutamyl transpeptidase，ggt），乳酸脱氢酶（lactate dehydrogenase，ldh）。
英语介绍体检表,作文结尾
英语介绍体检表,作文结尾英文回答：A physical exam, also known as a checkup, is a medical examination performed by a healthcare professional to assess a person's overall health and well-being. It typically involves a series of tests and measurements, including:Medical history: The healthcare professional will ask about the patient's past and present medical history, including any illnesses, surgeries, or medications.Physical examination: The healthcare professional will examine the patient's head, neck, chest, abdomen, and extremities, looking for any signs of illness or injury.Vital signs: The healthcare professional will measure the patient's blood pressure, heart rate, temperature, and respiratory rate.Laboratory tests: The healthcare professional may order laboratory tests, such as blood tests or urine tests, to check for any underlying medical conditions.Imaging tests: The healthcare professional may order imaging tests, such as X-rays or CT scans, to visualize the patient's internal organs and structures.Physical exams are typically performed on a regular basis, such as once a year, to screen for any health problems and to monitor overall health. They can also be performed more frequently if a person is experiencing symptoms of an illness or injury.There are many benefits to getting regular physical exams. These benefits include:Early detection of health problems: Physical exams can help to detect health problems early on, when they are most treatable. This can help to prevent serious health problems or even death.Monitoring of chronic conditions: If a person has a chronic condition, such as diabetes or heart disease, regular physical exams can help to monitor the condition and make sure that it is being managed properly.Health education: Physical exams can be a good opportunity to learn about your health and how to improve it. The healthcare professional can provide you with information on healthy eating, exercise, and otherlifestyle factors.Overall, physical exams are an important part of maintaining good health. By getting regular physical exams, you can help to detect health problems early on, monitor chronic conditions, and learn about your health and how to improve it.中文回答：体检，也称为健康检查，是由医疗专业人员进行的一项医学检查，用于评估个人的整体健康状况和健康状况。
英文健康体检表CERTIFICATEOFHEALTH
英文健康体检表C E R T I F I C A T E O F H EA L T HSANY标准化小组 #QS8QHH-HHGX8Q8-GNHHJ8-HHMHGN#健康诊断书CERTIFICATE OF HEALTHPlease fill out (PRINT/TYPE) in Japanese or English.氏名生年月日□男Male Name： , Date of Birth: ／／□女Female Family name First name , Middle nameApplicantPlease answer the questions below before submitting to a physician for your physical examination.1. 过去5年间に以下の病気あるいは大きな病気にかかったことがあれば记入してください。
Please check the list of diseases below and/or specify if you have had in the past five years.□ぜんそくAsthma □结核Tuberculosis □マラリアMalaria □てんかん Epilepsy □糖尿病 Diabetes □心臓病Heart Disease □肾臓病 Kidney Disease □肝臓病 Liver Disease □精神疾患 Psychosis□その他Other（）2.薬、食べ物、动物、その他でアレルギーがありますか。
はいいいえDo you have any allergies to drugs ,foods, animals and other Yes ／No具体的に记入してください。
Please specify.( )3.现在、何かの病気で薬を常用していますか。
はいいいえAre you taking medication now Yes ／ No 病名Disease 服用薬 medication( ) （）Physician1. 身体検査Physical Examination身长体重血液型 RH ＋Height cm Weight kg Blood Type － A B O AB血圧Blood Pressure mm/Hg ～mm/Hg视力Eyesight (R) (L) (R) (L) 色覚异常の有无□正常normal 裸眼without glasses 矫正 with glasses or contact lenses color blindness □异常 impaired聴力□正常 normalHearing □低下 impaired2. 申请者の胸部について、聴诊とX线検査の结果を记入してください。
健康诊断书样式-韩国驻武汉总领馆
The examination was performed as above.
执照号码(License No.): 检 查 结 果
(Summary of the examination)
/ 医生姓名(Name of Physician):
(签章)
对受检者停留的意见
(Remarks about examinee’s domestic stay)
仔细检查的必要性
(Additional close examination)
以上是对受检者健康状态的结果与评估。
We hereby certify that the examinee's heath status is assessed as above.
dd.mm.yyyy.
○○○○医院 (印章)
检 查 内 容
身高(Height) cm Physical examination and Chest X-ray 体重(Weight) Kg 血 压 Pressure) (Blood / mmHg
检查日(Date 检查 □ 3.结核菌素试验 □ 4.血液检查 □
1.胸部X线检查 □
I. 结果(1) (Result): 非特异所见(Non-specific) □ 非活动性结核(Inactive TB) □ 活动性结核 (Active TB) □ → 3-1. 传染性(Infective) □, 非传染性(Non-infective) □ → 3-2. 感受性结核(Drug-sensitive TB) □, 多剂耐性结核(MDR TB) II. 治疗结果(2) (Treatment Outcomes) - For person who has TB history 治疗中(Under treatment) □, 完治(Cured) □ 完了(Completed Treatment) □ 治疗失败(Failed) □ 治疗漏落(Defaulted) □
外国人体格检查表FOREIGNERPHYS
Skin
淋巴结
Lymph nodes
耳
Ears
鼻
Nose
扁桃体
Tonsils
心
Heart
肺
Lungs
腹部
Abdomen
脊柱
Spine
四肢
Extremities
神经系统
Nervous system
其它所见
Other abnormal findinest X-ray
Do you have any of the following diseases or disorders endangering the public order and security?
(Each item must be answered “Yes” of “No”)
毒物瘾Toxicomania………………………………………………………………………□No□Yes
斑疹伤寒Typhus fever□No□Yes菌痢Bacillary dysentery□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Viral hepatitis□No□Yes
猩红热Scarlet fever□No□Yes产褥期链球Puerperal streptococcus infection
回归热Relapsing fever□No□Yes菌感染□No□Yes
伤寒和付伤寒Typhoid and paratyphoid fever□No□Yes
流行性脑脊髓膜炎Epidemic cerebrospinal meningitis□No□Yes
幼儿健康证明英文模板
幼儿健康证明英文模板BIRTH CERTIFICATE“The Medical Certificate ofFull name of baby: Male Female(√)Date of birth: October 7, 20xx 00:20Birth”is formulated according to“The law of the People’s Republic of China on Maternal and Infant Health Care”. It is a legal medical certificate of people born in the People’s Republic of China. It is taken care of by the Newborn’s father and mother or guardian. Can not be sold, lent or alerted in private. And it is referred to upon civil registration.MINISTRY OF HEALTH OF THE PEOPLE’S REPUBLIC OF CHINA (Seal)Place of birth: (Province)(City) (County/District)(Township) Gestation (week) 39 (week)Health status: Well □√Normal □Weak □Weight: 3200gHeight: 52cmFull name of mother: Age: 29 Nationality: China Nationality: Han Identity card No.:Full name of father: Age: 29 Nationality: China Nationality: Han Identity card No.:Type of place General hospital □√MCH hospital □Home □Other ____ □Name of facility:Birth certificate No.: Date of issue:“The Medical Certificate of Birth”is formulated according to “The law of the People’s Republic of China on Maternal and Infant Health Care”. It is alegal medical certificate of people born in the People’s Republic of China. It is taken care of by the Newborn’s father and mother or guardian. Can not be sold, lent or alerted in private. And it is referred to upon civil registration.Special Seal for Beijing City Birth Medical Certification of Beijing Obstetrics and Gynecology HospitalIssuing organization (Seal)。
英语作文健康证明模板
英语作文健康证明模板英文回答：Health Certificate Template。
Personal Information。
Name:Date of Birth:Gender:Occupation:Address:Contact Number:Medical History。
Current Medications: List all medications you are currently taking, including prescription and over-the-counter drugs.Allergies: List any allergies you have, including food, medication, or environmental allergies.Immunization Status: List all immunizations you have received, including dates and types.Past Medical Conditions: Describe any significant medical conditions you have had in the past, including treatments received and outcomes.Family Medical History: Describe any significant medical conditions that run in your family, including those that are hereditary.Physical Examination。
General Appearance: Describe the patient's overallappearance, including weight, height, and body mass index (BMI).Vital Signs: Include blood pressure, pulse,respiration rate, and temperature.Head, Neck, and Thyroid: Describe any abnormalities in the head, neck, or thyroid area.Cardiovascular System: Auscultate the heart and lungs for any murmurs, rales, or wheezes.Respiratory System: Note any abnormalities in the respiratory system, such as shortness of breath or coughing.Gastrointestinal System: Palpate the abdomen for any tenderness, masses, or hernias.Genitourinary System: Examine the external genitalia and perform a prostate exam if indicated.Musculoskeletal System: Assess the patient's range ofmotion and joint function.Neurological System: Test the patient's reflexes, coordination, and sensation.Psychiatric Examination: Evaluate the patient's mental health, including mood, affect, and thought processes.Laboratory Tests。
体检证明英语作文格式
体检证明英语作文格式Dear [Recipient's Name],I am writing to certify that I have recently undergone a comprehensive physical examination at [Hospital/Clinic Name] and have been found to be in good health. The purpose of this letter is to provide evidence of my physical fitness, which may be required for various purposes such as employment, travel, or educational endeavors.The examination took place on [Date of Examination] and was conducted by [Doctor's Name], a certified medical professional with extensive experience in this field. The following tests were performed:1. Blood Test: This test was conducted to check for any abnormalities in my blood, including sugar levels,cholesterol levels, and any signs of infection or disease.2. Urinalysis: A urine sample was collected and analyzed to determine the presence of any substances that could indicate health issues.3. Cardiovascular Examination: My heart and blood pressure were checked to ensure there are no signs of cardiovascular diseases.4. Respiratory Function Test: This test was performed toevaluate the efficiency of my respiratory system.5. General Physical Examination: A thorough check-up was done to assess my overall physical condition, including height, weight, and body mass index (BMI).6. Vision and Hearing Test: To ensure that my vision and hearing are within normal ranges.7. Dental Examination: A check-up was performed to confirm the health of my teeth and gums.The results of all these tests have been compiled in a detailed report, which is attached to this letter. According to the medical report, I am in excellent health with no significant health concerns or issues.I would like to assure you that I take my health seriously and have been proactive in maintaining a healthy lifestyle through regular exercise, a balanced diet, and regular medical check-ups.Please feel free to contact me or [Doctor's Name] at [Contact Number] if you require any additional information or clarification regarding my physical examination.Thank you for your time and consideration.Sincerely,[Your Full Name][Your Address][City, State, Zip Code] [Email Address] [Phone Number][Date]。
2《外国人体格检查记录》表
外国人体格检查记录外国人体格检查记录PHYSICAL EXAMINATION RECORD FOR FOREIGNER体检说明EXPLANATION OF THE PHYSICAL EXAMINATION1．在华学习六个月以上的外国留学生，应按照“外国人体格检查记录”进行体格检查。
体检表贴照片处，应有医院印章，否则，视体检表无效。
Ⅰ．The foreign students, who intend to study in China for 6 months or more, should go through a physical check-up before they come to China, 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．体检表应填写清楚，体检报告应附有X光透视胸片及霍乱、黄热、鼠疫、麻风、性病、开放性肺结核、艾滋病、肝功能、澳抗和精神病的化验室检查报告。
外国留学生到浙江旅游职业学院报到时，我们将体检表及化验室检查报告送至浙江省卫生检疫局查验。
凡体检查验不合格者，需在杭州市卫生检疫局重新体检，费用自理。
Ⅱ．All the items of this form should be filled in carefully and clearly. The report should be attached with the negative film for Chest X-ray exams, and the examination certificates for laboratory exams (Serodiagnosis), which include exams on Cholera, Yellow fever, Plague, Leprosy, Venereal Disease, Opening lung tuberculosis, AIDS, Psychosis, Liver function and HB&AG. On their arrival at Tourism College of Zhejiang , the Record (a original copy) and laboratory exam certificates should be sent to Zhejiang Quarantine Bureau for check. Those whose exam are not qualified should get the physical re-check up done in Hangzhou . The expenses should be covered by themselves.3.体检应在来华一个月前在公立医院进行，凡在私立医院体检者，应取得公证部门的公证。
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健康诊断书CERTIFICATE OF HEALTH
Please fill out (PRINT/TYPE) in Japanese or English.
氏名生年月日□男Male Name： , Date of Birth: ／／□女Female Family name First name , Middle name
Applicant
记の质问に答えてください。
Please answer the questions below before submitting to a physician for your physical examination.
1. 过去5年间に以下の病気あるいは大きな病気にかかったことがあれば记入してください。
Please check the list of diseases below and/or specify if you have had in the past five years.
□ぜんそくAsthma □结核Tuberculosis □マラリアMalaria □てんかん Epilepsy □糖尿病 Diabetes □心臓病Heart Disease □肾臓病 Kidney Disease □肝臓病 Liver Disease □精神疾患 Psychosis
□その他Other（）
2.薬、食べ物、动物、その他でアレルギーがありますか。
はいいいえ
Do you have any allergies to drugs ,foods, animals and other? Yes ／No
具体的に记入してください。
Please specify.
( )
3.现在、何かの病気で薬を常用していますか。
はいいいえ
Are you taking medication now? Yes ／ No 病名Disease 服用薬 medication
( ) （）
Physician
1. 身体検査
Physical Examination
身长体重血液型 RH ＋
Height cm Weight kg Blood Type － A B O AB
血圧
Blood Pressure mm/Hg ～mm/Hg
视力
Eyesight (R) (L) (R) (L) 色覚异常の有无□正常normal 裸眼without glasses 矫正 with glasses or contact lenses color blindness □异常 impaired 聴力□正常 normal
Hearing □低下 impaired
2. 申请者の胸部について、聴诊とX线検査の结果を记入してください。
X线検査の日付も记入すること（6ヶ月以上前の検査は无効）
Please describe the results of physical and X-ray examinations of applicant’s chest (X-ray taken more than 6 months prior
肺□正常normal 心臓□正常normal
Lung □异常 impaired Heart □异常 impaired
↓
Date 心电図
Film No Electrocardiograph:
□正常normal
Describe the condition of applicant’s lung. □异常 impaired
３．検査Laboratory tests
検尿Urinalysis
糖Glucose（）, 蛋白Protein（）, 潜血Occult blood（）
血液検査Blood test
赤血球数 WBC count：×104 /μl, 白血球数WBC count： /μl
４．Please describe your impression.
５．志愿者の既往歴,诊察?検査の结果から判断して,现在の健康状况は十分に留学に耐えうるものと思われますか？
In view of the applicant’s history and the above findings, do you think his/her health status is adequate to pursue study in Japan? はいいいえ YES / NO
日付署名
Date: Signature
医师氏名
Physician’s name in print：
検査施设名
Office／Institution
所在地
Address。