英语翻译Physical Examination certificate,Asia UniversityFull name:______ Nationality:________Date of birth:______ Sex:Male/Female_______Address:____________________________________1.Height:_____cm Weight:________kgEye sight:___(R) ______ (L) ____

英语翻译Physical Examination certificate,Asia UniversityFull name:______ Nationality:________Date of birth:______ Sex:Male/Female_______Address:____________________________________1.Height:_____cm Weight:________kgEye sight:___(R) ______ (L) ____
英语翻译
Physical Examination certificate,Asia University
Full name:______ Nationality:________
Date of birth:______ Sex:Male/Female_______
Address:____________________________________
1.Height:_____cm Weight:________kg
Eye sight:___(R) ______ (L) ____With glasses:_____(R) __ (L) ______
Color:Normal /Abnormal
Hearing:(R) Normal/Abnormal
(L)\x05Normal/Abnormal
Urinalysis
Protein - + ++ +++
Sugar - + ++ +++
Urobilinogen - + ++ +++
HBs:
Antigen - +
Antibody - +
Blood pressure:_____mmHg blood type:_____RH___-/+
2.X-ray:（）direct （）indirect
Please comment on condition of applicant’s lungs,and give date of test.
3.Please describe in detail if you find any disease,including chronic ones,or physical handicaps.
Please indicate past illnesses if applicant has had any.
4.I diagnose that the applicant’s health and physical conditions are;
( ) Excellent ( ) Good ( ) Fair ( ) Poor
I hereby certify the above diagnosis.
Physician’s signature:______________________________________
Name of physician:________________________________________
Name of the clinic:________________________________________
Date of examination:_______________________________________
This form must be completed by a physician.

英语翻译Physical Examination certificate,Asia UniversityFull name:______ Nationality:________Date of birth:______ Sex:Male/Female_______Address:____________________________________1.Height:_____cm Weight:________kgEye sight:___(R) ______ (L) ____
Physical Examination certificate, Asia University
亚洲大学体检证明
Full name: ______ Nationality: ________
全名： 国籍：
Date of birth: ______ Sex: Male/Female_______
出生日期： 性别：男/女
Address: ____________________________________
地址：
1. Height: _____cm Weight: ________kg
身高： 厘米 体重： 公斤
Eye sight: ___(R) ______ (L) ____With glasses: _____(R) __ (L) ______
视力： （右） （左） 戴眼镜： （右） （左）
Color: Normal /Abnormal
色觉：正常/非正常
Hearing: (R) Normal/Abnormal
听力：（右）正常/非正常
(L)Normal/Abnormal
（左）正常/非正常
Urinalysis
尿检
Protein - + ++ +++
蛋白质
Sugar - + ++ +++
糖
Urobilinogen - + ++ +++
尿胆素原
HBs:
乙肝表面抗体：
Antigen - +
抗原
Antibody - +
抗体
Blood pressure: _____mmHg blood type: _____RH___-/+
血压： mmHg 血型：
2. X-ray: （）direct （）indirect
X射线 直接 间接
Please comment on condition of applicant’s lungs, and give date of test.
请评价受检者的肺,并标注测试日期
3. Please describe in detail if you find any disease, including chronic ones, or physical handicaps.
如果发现任何疾病包括慢性病或身体障碍,请详细说明
Please indicate past illnesses if applicant has had any.
请说明病史,如果有
4. I diagnose that the applicant’s health and physical conditions are;
受检者的健康及身体状况诊断如下：
( ) Excellent ( ) Good ( ) Fair ( ) Poor
优秀 良好 一般 很差
I hereby certify the above diagnosis.
在此证明如上诊断
Physician’s signature: ______________________________________
医师签名
Name of physician: ________________________________________
医师名字
Name of the clinic: ________________________________________
诊所名称
Date of examination: _______________________________________
检查日期
This form must be completed by a physician.
此表必须由医师填写