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1.2.3.4.5.6.NOTES This certificate is valid only if completed with the date of iue, signature of physician and the official stamp of the Entry-Exit Inspection and Quarantin authorities of the People’s Republic of China.The validity of this certificate shall extend for a period of one year starting date of iue.The owner must always keep this certificate with himself against inspection on departing from or arriving in a country or at his place residing.The “Normal” status in the certificate is valid only as of when the examinee took the exams.The certificate shows the examinee has had the medical exams, and it records the medical results accurately, which only indicates the health condition of the examinee when the exams were taken.Any amendment of this certificate, or erasure, or misuse by other person, may render it
invalid.No.Surname:Given Names:
Sex:Date of Birth:
Nationality: CHINESEBlood Type:
Addre of lue:
General check
Height: cmWeight : kgPulse rate: times/min
BP: mmHgTemperature:℃
Medicine & Surgery
Skin, Sclera, Lymph Nodes: Normal
Head & Neck: Normal
Chest & Lungs: Normal
Heart: Auscultation heart:Normal
Abdomen: Normal
Spine & Extremities: Normal
Neuropsychiatric System: Normal
Genitourinary System: Normal
E.E.N.T.Innc.Vision: LeftRightCorr.Vision: LeftRight
Color Sense:
Hearing: Left NormalRight Normal
Eyes, Ears, Nose, Throat: Normal
ECG
Abdomen Ultrasound(Liver, Gallbladder, Spleen, Kidney)
Liver, gallbladder, spleen, double kidney , echo camer no abnormal findings.Chest X-ray
No abnormal findings of heart lungs and diaphragm.Laboratory Tests
Anti-HIV: Negative
Syphilis Serology: Negative
HBsAg: Negative
Anti-HCV: Negative
ALT(GPT):(Normal: 5-40)
Blood Routine
WBC:
RBC:
PLT:
HGB:
NEUT%:
LYM%:
Laboratory Tests
Urine Routine
GLU:
PRO:
ERY:
LEU:
Others: ********
General Comments
None of diseases or disorders found endangering the public order and security.Name of doctor in charge:
Signature of doctor in charge:
Date of iue:
Official stamp
Id card:
