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鏀惧ぇ瀛椾綋  缂╁皬瀛椾綋 2005-03-17 00:00:00  鏉ユ簮锛氳川妫€鎬诲眬  娴忚娆℃暟锛�2587
鏍稿績鎻愮ず锛氬崼鐢熼儴鍏充簬瀵广€婁腑鍗庝汉姘戝叡鍜屽浗鍥藉鍗敓妫€鐤硶瀹炴柦缁嗗垯銆嬫湁鍏虫潯娆剧殑瑙i噴
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鍙戝竷鏂囧彿 1991-05- 29
鍙戝竷鏃ユ湡 1991-05-28 鐢熸晥鏃ユ湡 鏆傛棤
鏈夋晥鎬х姸鎬� 搴熸鏃ユ湡 鏆傛棤
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NOTE

1.This certificate is valid only if completed with the date of issue,

signature of physician and the offcial stamp of The Frontier Health

and Quarantine Service.

2.The owner must always keep this certificate with himself

against inspection on departing from or arriving in a country or at his

place of residing.

3.Any amendment of this certificate,or erasure,ormisuse by oth-

er person, may render it invalid.

锛堝皝搴曪級



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锝淣ame 锝� 锝�

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锝滄€у埆 鐢凤紡濂� 锝� 锝�

锝淪ex Male/Female 锝� 锝�

锝滐紞锛嶏紞锛嶏紞锛嶏紞锛嶏紞锛嶏紞锛嶏紞锛嶏綔 鐗� 锝�

锝滃嚭鐢熸棩鏈� 锝淧hoto 锝�

锝淒ate of birth 锝� 锝�

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锝滃浗绫� 锝�

锝淣ationality 锝�

锝滐紞锛嶏紞锛嶏紞锛嶏紞锛嶏紞锛嶏紞锛嶏紞锛嶏紞锛嶏紞锛嶏綔

锝滆韩楂� 鍘樼背 锝� 澶囨敞 锝�

锝淗eight cm 锝淩emarks 锝�

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锝滀綋閲� 鍏枻 锝� 锝�

锝淲eight kg 锝� 锝�

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锝滆鍨� 锝� 锝�

锝淏lood type 锝� 锝�

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锛堢涓€椤碉級



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锝� 鍑哄浣撴牸妫€鏌� 锝�

锝� Record of Physical Examination for Departure 锝�

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锝滆鍘� 姣背姹炴煴锝滆剦鎼� 娆★紡鍒� 锝�

锝淏lood pressure mmHg 锝淧ulse rate time/min 锝�

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锝滃彂鑲叉儏鍐� 锝� 锝滆惀鍏绘儏鍐� 锝� 锝�

锝淒evelopment 锝� 锝淣ourishment 锝� 锝�

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锝淪kin 锝� 锝淟ymph nodes 锝� 锝�

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锝� 锝滆鍔� 宸 鐭瑙嗗姏 宸 锝�

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锝� Eyes 锝� Vision 锝�

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锝� 锝滆鲸鑹插姏 鍏朵粬 锝�

锝� 锝淐olour sense Others 锝�

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锝滆€炽€侀蓟銆佸枆 锝� 锝�

锝� E.N.T 锝� 锝�

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锝滅敳鐘惰吅 锝� 锝�

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锝滆偤閮� 锝� 锝�

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锝滆吂閮� 锝� 锝�

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锛堢浜岄〉锛�



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锝淪pine 锝� 锝淓xtremities 锝� 锝�

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锝滄硨灏跨敓娈栫郴 锝� 锝滆倹闂� 锝� 锝�

锝淕enitourinary 锝� 锝淎nus 锝� 锝�

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锝滅缁忕郴缁� 锝� 锝�

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锝渟ystem 锝� 锝�

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锝滃績鐢靛浘 锝� 锝�

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锝滅璇佹棩鏈� 锝滀娇鐢ㄦ湡锛戝勾 锝�

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锝滃尰鐢熺瀛� 妫€鐤満鍏崇洊绔� 锝�

锝淪ignature of Physician Official stamp锝�

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锛堢涓夐〉锛�



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锝� 鍏ュ浣撴牸妫€鏌� 锝�

锝� Record of Physical Examination for Entry 锝�

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锝滆鍘� 姣背姹炴煴锝滆剦鎼� 娆★紡鍒� 锝�

锝淏lood pressure mmHg 锝淧ulse rate time/min 锝�

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锝滃彂鑲叉儏鍐� 锝� 锝滆惀鍏绘儏鍐� 锝� 锝�

锝淒evelopment 锝� 锝淣ourishment 锝� 锝�

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锝� 锝滆鲸鑹插姏 鍏朵粬 锝�

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锝滆吂閮� 锝� 锝�

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锛堢鍥涢〉锛�



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锝滃績鐢靛浘 锝� 锝�

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锝滆兏閮╔绾挎鏌� 锝� 锝�

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锝滅璇佹棩鏈� 锝滀娇鐢ㄦ湡锛戝勾 锝�

锝� Date 锝淓xpected period one year 锝�

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锝滃尰鐢熺瀛� 妫€鐤満鍏崇洊绔� 锝�

锝淪ignature of physician Official stamp 锝�

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锛堢浜旈〉锛�
 

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鎺ㄨ崘鍥藉娉曡
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