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1、电子科技大学 2016 年外国人体格检查记录PHYSICAL EXAMINATION RECORD FOR FOREIGNER姓 名 Name性别 男 Male Sex女 Female出生日期YMD Date of Birth照片 Photo (put hospital seal across the photo)现在通讯地址 Present mailing address血型 Blood type国籍 Natio-n ality出生地 Birth Place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 d
2、iseases? (Each item must be answered“Yes”or“No”)斑 疹 伤 寒 Typhus fever NoYes细菌性痢疾 Bacillary dysenteryNoYes小儿麻痹症 PoliomyelitisNoYes布氏杆菌病 BrucellosisNoYes白喉 DiphtheriaNoYes病毒性肝炎 Viral hepatitisNoYes猩 红 热 Scarlet feverNoYes产褥期链球菌 Puerperal streptococcus NoYes回 归 热 Relapsing feverNoYes感 染 InfectionNoYes伤寒
3、和副伤寒 Typhoid and paratyphoid feverNoYes流行性脑脊髓膜炎Epidemic cerebrospinal meningitisNoYes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 secure? (Each item must be answered “Yes”or“No”) 毒物瘾 Toxicomania NoYes 精神错乱 Mental confusi
4、on NoYes 精神病 Psychosis：躁狂型Manic psychosis NoYes 妄想型Paranoid psychosis NoYes 幻觉型Hallucinatory psychosis NoYes 身 高/Height (厘米/ cm)体 重/ Weight (公斤/ kg)血压/ Blood pressure (毫米汞柱/mmHg)发育情况 Development营养情况 Nourishment颈部 Neck视 力 Vision左 L 右 R矫正视力 Corrected vision左 L 右 R眼 Eyes辨 色 力/Color sense皮肤/Skin淋巴结/Lymp
5、h 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其他所见 Other abnormal findings胸部 X 线检查/Chest X-ray exam心电图/ECG化验室检查(包括艾滋病、 梅毒血清学诊 断)/Laboratory Exam (HIV, Syphilis Serodiagnosis)附上对以下项目的化验室报告：Please attach the results and data sheets for the following it
6、ems:AIDS.,Syphilis,ALT.,AST.,T-BIL.,and HBsAG.未发现患有下列检疫传染病和危害公共健康的疾病： None of the following diseases or disorders found during the present examination. 霍乱 Cholera性病 Venereal disease 黄热病 Yellow fever开放性肺结核 Opening lung tuberculosis 鼠疫 Plague艾滋病 AIDS 麻风 Leprosy精神病 Psychosis意见检查单位盖章 SuggestionOfficial
7、Stamp医师签字日期 Signature of physicianDate体检说明/体检说明/ EXPLANATION OF THE PHYSICAL EXAMINATION：EXPLANATION OF THE PHYSICAL EXAMINATION：1在华学习外国留学生，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。The foreign students, who intend to study in China, should go through a physical check-up beforethey come to China
8、, 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 isinvalid.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。外国留学生到电子科技大学报到时，我们将体检表及化验室检查报告送至成都市检验检疫局查验。凡体检查验不合格
9、者，需在成都市检验检疫局重新体检，费用自理。All the items of this form should be filled in carefully and clearly. The report should be attachedwith the negative film for Chest X-ray exams, and the examination certificates for laboratoryexams (Serodiagnosis), which include exams on Cholera, Yellow fever, Plague, Leprosy,
10、VenerealDisease, Opening lung tuberculosis, AIDS, Psychosis, Liver function and HBsAG. On their arrivalat University, the Record (an original copy) and laboratory exam certificates should be sent toChengdu Quarantine Bureau for check. Those whose exam is not qualified should get the physicalre-check
11、 up done in Chengdu. 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。到达电子科技大学报到时，体检时间不得超过六个月，否则应在成都重新体检，费用自理。The physical examination should be taken in the public hospitals one month before their departure,if the physical check-up is done at a private hospital,
12、the student should get the certificatenotarized. If the physical check-up is over 6 months old on the day of their registration, theyshould have re-checked up in Chengdu. The expenses should be covered by themselves.4体检表是办理入境签证及在华居留手续所需文件之一，留学生到达电子科技大学报到时，应提交正本。The Physical Examination Record is one of the documents that are needed in the process of goingthrough the visa formalities. The students should bring the original copy along with them whenthey come to China.文章来源：文彦考研旗下电子科技大学考研网
