国际旅行健康证明书.doc

1. ? ? ? ? ? ? b? -1. 2. 3. 4. /bb1. 2. 3. 4. 5. 1. 2. 3. 1. 2. 3. 4. (), , , , , , , , , , , , , , : () , , , , , , , , , , (), , , , , , , , , 1. 2. 3. 4. 1.2.3.4.5.invalid.no.surname: given names:sex: date of birth:nationality: chinese blood type:address of lssue:general checkheight: cm weight : kg pulse rate: times/minbp: mmhg temperature: medicine & surgeryskin, sclera, lymph nodes: normalhead & neck: normalchest & lungs: normalheart: auscultation heart : normalabdomen: normalspine & extremities: normalneuropsychiatric system: normalgenitourinary system: normale.e.n.t.innc.vision: left right corr. vision: left rightcolor sense:hearing: left normal right normaleyes, ears, nose, throat: normalecgabdomen ultrasound (liver, gallbladder, spleen, kidney)liver, gallbladder, spleen, double kidney , echo camer no abnormal findings.chest x-rayno abnormal findings of heart lungs and diaphragm.laboratory testsanti-hiv: negativesyphilis serology: negativehbsag: negativeanti-hcv: negativealt(gpt): (normal: 5-40)blood routinewbc:rbc:plt:hgb:neut%:lym%:laboratory testsurine routineglu:pro:ery:leu:others: *none of diseases or disorders found endangering the public order and security. name of doctor in charge:signature of doctor in charge:date of issue:official stampid card:()112100025-523457008:00-11:308:00-11: