学生体检证明中英文由刀豆文库小编整理，希望给你工作、学习、生活带来方便，猜你可能喜欢“学生体检证明”。
学生体检表
学生姓名：出生日期：
身高体重血压及血型脉搏
视力听力
校正前右眼/左眼/右耳/左耳/
校正后右眼/左眼/右耳/左耳/
呼吸道系统心脏、心血管系统
神经系统肌肉骨骼系统
泌尿系统白蛋白尿糖矿物质耳鼻喉肝脾
腹腔皮肤生殖器
是否有过敏现象？〇有〇无如有，请做进一步解释
该生是否适合参加体育运动？〇适合〇不适合在项目期间，学生只能携带医生所开处方药，请详细说明学生需要携带的药物：
学生病史
请用有或无回答下表相关问题，如果回答为有，请做进一步的解释：
无有解释
肾病
先天性畸形
神经错乱
眼症
住院史
肺病
心脏病
内分泌失调
饮食失调
月经不调
口腔问题
癫痫
手术史
精神错乱
强迫症
抑郁症
我，下文签名者，已认真研究申请人的病例，并对申请人进行全面体检，特此证明所有重要的体检信息已经在此表上注明，以上信息完整无误。
医师签字：日期：
医师姓名：
医师地址：
中英文都请加盖医院公章
MEDICAL INFORMATION
Student Name: __________________________Date of Birth: ____ /____ /____MM DD YEAR
PHYSICAL EXAMINATION OF STUDENT
Height_______Weight________________BloodPreure/Type______________Pulse_____________
Visual AcuityHearing
(Without Correction)R _____ /_____ L _____ /_____R _____ /_____ L _____ /_____
(With Correction)R _____ /_____ L _____ /_____R _____ /_____ L _____ /_____
Respiratory System _________________________ Cardiovascular SystemNeurological System______Urinalysis S.B.___________________Alb ___________________SugarE.N.T.SpleenAbdomen _______________________Skin __________________GenitalsAllergies? YES NO If yes, please explain:Students should only bring medications prescribed by their doctor.Please explain clearly, in English,what medications the student needs while on the program:Is this student physically able to participate in sports?O YES O NO
STUDENT’S MEDICAL HISTORY
Please mark answer yes or no.If you answered “yes”, please explain to the right.NoYesExplanation
Kidney Disease________
Congenital anomalies________
Neurological disorders________
Eye problems________
Hospitalization________
Pulmonary disease________
Cardiac disease________
Endocrine disorder________Eating disorder________Menstrual disorder________Orthopedic problems________Convulsions
Mental disorders________________Operations________ADD or ADHD________Depreion________
I, the undersigned, have given a thorough physical examination and reviewed the medical history of this
student.I certify that all important medical information has been included, and that the above information is
complete and accurate.Physician’s Signature: __________________________________________________________ Date:Physician’s Name:Physician’s Addre:
