外国人体格检查记录PhysicalExaminationRecordfor

外国人体格检查记录

PHYSICAL EXAMINATION RECORD FOR FOREIGNER

体

检

说

明

EXPLANATION OF THE PHYSICAL EXAMINATION

1

．在华 学习或工作六个月以上的外国人，应按照“外国人体格检查记录”进行

体格检查。

The foreigners, who intend to study or work in China for 6 months or more, should go

through

a

physical

examination

before

they

come

to

China

according

to

the

requirements of Physical Examination Record for Foreigners.

2

．外籍人员入境前的健康体检应由所在国公立医院或我使馆认定医院 检查，检

查结果、健康证明书由当地公证机关及我国使（领）馆认证。体检表贴照片处，

应有医院印章。健康检查结果应有医院盖章、医师签字、检查日期。否则，视体

检表无效。

The physical examination should be done in a public hospital or a hospital recognized

by

Chinese

Embassy.

Result

of

the

examination

should

be

notarized

by

local

notarizing authority and certified by Chinese Embassy. The hospital seal is supposed

to be put across the photo on the Examination Record. Seal of hospital, signature of

physician, and date of examination are required. Otherwise, the record will be viewed

as invalid.

3

．体检项目应包括国际检疫传染病、爱滋病、性病、开放性肺 结核病、精神病、

麻风病等，血清学检验报告单应包括

Anti -HIV

,

RPR,

TPPA,

HbsAg,

AntiHCV

, < /p>

ALT/GPT

等项目，

X

光检查报告及胸片。体检表应填写清楚。

Examination

of

International

Quarantiable

Diseases,

AIDS,

Venereal

Disease,

Opening

Lung

Tuberculosis,

Psychosis,

Leprosy,

etc.

must

be

included.

Laboratory

Exam Report, X-ray Exam Report and Chest X-ray are supposed to be attached. And

Anti-HIV

,

RPR,

TPPA,

HbsAg,

AntiHCV

,

ALT/GPT

should

be

shown

in

the

Laboratory Exam Report. All items of this form have to be filled carefully and clearly.

< br>4

．报到时，体检时间不得超过五个月。

The

examination

should

be

done

no

longer

than

5

months

ago

on

the

day

of

registration.

5

．体检表是办理来华手续所需文件 之一。

The

Physical

Examination

Form

is

one

of

the

documents

that

are

needed

in

the

process of going through the visa formalities.

外

国

人

体

格

检

查

记

录

PHYSICAL EXAMINATION RECORD FOR FOREIGNER

姓名

Name

性别

□男

Male

Sex

□女

Female

出生地址

Birth place

出生日期

Birth Day- Month-Year

照片

（加盖检查

单位印章）

Photo

(Stamped

Official Stamp)

现在通讯地址

Present mailing address

国籍

Nationality

血型

Blood

type

过去是否患有下列疾病：

（ 每项后面请回答“否”或“是”

）

Have you ever had any of the following diseases?

(Each item must be answered “Yes” or “No”)

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

No

□

Yes

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

是 否患有下列危及公共秩序和安全的病症：

（每项后面请回答“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” or “No”)

毒

物

瘾

Toxicomania

………………………………………………… ……………………□

No

□

Yes

精神错乱

Mental

……………………………………………………………… …□

No

□

Yes

精

神

病

Psychosis

：躁狂型

Manic

psychosis

……………………………………………□< /p>

No

□

Yes

妄想症

Paranoid

psych osis

…………………………………………□

No

□

Yes

幻觉型

Hallucinatory

psychosis

……………………………………□

No

□

Yes

身高

厘米

Height

cm

发育情况

Development

视

力

左

L

Vision

右

R

辨色力

Colour sense

耳

Ears

心

Heart

体重

公斤

Weight

kg

营养情况

Nourishment

矫正视力

左

L

Corrected vision

右

R

皮肤

Skin

鼻

Nose

肺

Lungs

血

压

千

帕

Blood

pressure

KPa

颈部

Neck

眼

Eyes

淋巴结

Lymph nodes

扁桃体

Tonsils

腹部

Abdomen