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1、【附件】健康診斷書照片CertificateCertificate ofof HealthHealth(Photo)34姓名(Name)性別(Sex)M(男)F(女)鋼印或騎縫章出生日期(Date of Birth)電話號碼(Phone Number)護照號碼(Passport Number)地址(Address)檢檢 查查 內(nèi)內(nèi) 容容PhysicalPhysical examinationexamination andand ChestChest X-rayX-ray身高(Height)體重(Weight)血壓(BloodPressure)cm Kg /mmHg 檢查日(Date of Ch
2、est)/1.胸部X線檢查 2.痰結核菌檢查 3.結核菌素試驗 4.血液檢查 I.I.結果(1)(1)(Result):(Result):非特異所見(Non-specific)非活動性結核(Inactive TB)活動性結核(Active TB)3-1.傳染性(Infective),非傳染性(Non-infective)3-2.感受性結核(Drug-sensitive TB),多劑耐性結核(MDR TB)II.II.治療結果(2)(2)(Treatment(Treatment Outcomes)Outcomes)-ForFor personperson whowho hashas TBTB h
3、istoryhistory治療中(Under treatment),完治(Cured)完了(Completed Treatment)治療失敗(Failed)治療漏落(Defaulted)對上述項目進行了檢查。The examination was performed as above.執(zhí)照號碼(License(License No.)No.):/醫(yī)生姓名(Name(Name ofof Physician):Physician):(簽章)檢 查 結 果(Summary of the examination)對受檢者停留的意見(Remarks about examinees domestic stay)仔細檢查的必要性(Additional close examination)以上是對受檢者健康狀態(tài)的結果與評估。We hereby certify that the examinees heath status is assessed as above.dd.mm.yyyy.dd.mm.yyyy.醫(yī)院 (印章)
健康診斷書樣式-韓國駐武漢總領館
