新员工入职体检表（中英文版）.docx

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1、体检表姓名 Name性别 Sex出生日期Date of b i rth照片 Photo民族 Race婚姻状况 Mar ita1 status籍贯 Origin Hometown文化程度Education Degree联系 Te1 ephone No职业 Occupati on公司/学校/ 其它 Company/Sch ool/Others报考职位 Register for examination of pos it ion护照及身份 证号码 Passport No and ID No请本人如实详细填写以下工程Please fill in the fol lowing items truthfu

2、11y(在每一项后的空格中打回答“有”或“无”，如故意隐瞒，后果自负)(1 n each of these spaces after playing J The answer i s yesor no”, Such as i ntent i ona 1 1 y concealed, the consequences)病名Name of d i sease有Yes无 No详细说明 Deta i1病名Name of d i sease有Yes无 No详细说明 Deta i1高血压病 Hypertens i on糖尿病D i abetes冠心病 Coronary heart d i sease甲亢H

3、yperthyro i d i sm风心病Rheumat i c heart d i sease贫血 Anemia先心病 Congenital heart d i sease癫痫Ep i1epsy心肌病Card i omyopathy精神病Psychos i s支气管扩张Bronch i ectas i s神经官能症 Neuros i s哮喘 Asthma吸毒史Drug addiction肺气肿 Pulmonary emphysema肝炎 Hepatitis消化性溃疡Peptic ulcer结核病 Tuberculosis肝硬化Ci rrhosis性病 STDs胰腺疾病 Pancreatic

4、d i seases恶性肿瘤Ma 1i gnant tumor急慢性肾炎 Acute and chronic nephr itis手术史Operat i on肾功能不全 Rena 1 insufficiency严重外伤史 H i story of severe trauma结缔组织病Connect i ve t i ssue d i sease其他 Others备注：Remarks：受检者签字：Client signature：体检日期年月日Health Check Date：YearMonthDay身高 He ightCm体重 WeightKg血压 Blood Pressure/mmHg内科

5、 1nterna1 med i c i ne病史：曾患过何种疾病(起病时间及目前病症)。Name of di sease： Once i11nesses (The onset time and current symptoms)心脏 Heart心界The heart boundary杂音Noise心率次/分律Heart rateBPMLaw肺 Lung腹部Abdomen肝 Liver神经系统Nervous system脾Sp1een其它 Others建议Suggest i on医生签字 Physician s i gnature外科 Surgery病史：曾做过何种手术或有无外伤史(名称及时间)

6、，目前功能如何。Name of d i sease： Had done the operat i on or i f there i s a h i story of trauma(The name and year), The function how to。甲状腺Thyroid gland乳腺 Breast浅表淋巴结 Superficial1ymph node皮肤Skin脊柱四肢关节 Sp i ne and extremities joint头颅Head肛门生殖器Anogen ita1其它 Others建议Suggest i on医生签字 Physician s i gnature眼科 E

7、yes裸眼视力 Uncorrected v i sua1 acuity右Right矫正视力 Vision右Right医生签字 Physician s i gnature左Leftcorrecti on左Left色觉Color vision其它 Others建议Suggest i on医生签字 Phys i c i an s i gnature耳鼻喉科 Departme nt of ENT听力 Listening comprehensio n左耳The Left ear右耳The right ear耳部 Ear鼻部 Nasal咽部 Pharynx喉部 Throat其它 Others建议Sugge

8、st i on医生签字 Phys i c i an s i gnature口腔科 Oral cavity唇腭舌 Lip and palate homes颍下颌关节 Temporomandibula r joint腮腺 Parotid gland齿 Tooth口腔黏膜Oral mucosa其它 Others建议Suggest i on医生签字 Phys i c i an s i gnature妇科 Gynecolo gy病史/月经史：初潮 岁，经期/周期/，量(多、中、少)，末次月经Name of disease /Menstrual history： Menarche At the age o

9、f, Period/Cycle/, Volume (Many 、 Medium、 A few), Last menstrual period检查工程：1.已婚女性作外阴部检查、阴道窥器检查及阴道-腹部双合诊检查。2.未婚女性作外阴部检查、直肠-腹部双合诊检查。Inspection item： 1.Married women in external genital examination Vaginal speculum examination and vaginal and abdominal bimanual examinationo2. Unmarried female external

10、genital, rectal examination for abdominal double add up to。已婚女性(内诊) Married women (Internal examination)未婚女性(肛诊)Unmarried female (Anal examination)外阴 Vulva外阴 Vulva阴道 Vagina/宫颈 Gong Jing/宫体 Uterine body宫体 Uterine body附件Accessories附件Accessories建议Suggest i on医生签字 Phys i c i an s i gnature心电图Electrocard

11、iogram建议：医生签字：Suggestion：Physician signature：胸部X光片Chest X-ray建议：医生签字：Suggestion：Physician signature：检验工程Inspection item白细胞Routine bloodtest白细胞总数（WBC）及分类WBC count and classification血红蛋白HGB红细胞总数RBC血小板计数PLT血生化 Blood biochemistry丙氨酸氨基转移酶ALT尿素氮BUN天冬氨酸氨基转移酶AST肌酎CR葡萄糖GLU免疫Immune艾滋病病毒抗体HIV梅毒血清特异性抗体TPHA尿常规Ur

12、ine routine糖GLU蛋白质PRO胆红素TBIL尿胆原URO比重SG红细胞BLO酸碱度PH白细胞LEU镜检Microscopic examination血型Blood type腹部超声检查Abdominal ultrasound examination建议：,医生签字Suggestion：Physician signature：体检结论及建 议 Physical examination conclusions and suggestions体检医院盖章处Medical hospital seal总检医生签字年月日Examining physician signature：YearmonthDay