Name | 太阳能电灯 | Gender | Born | Marital Status | ||||||||
Education 盗汗吃什么药 | Nation | Occupation | ||||||||||
Address | ||||||||||||
work unit | ||||||||||||
Anamnesis | ||||||||||||
ENT | eyes | Eyesight | L | Eyesight Contact lens | L | The doctors advice （Signature） | ||||||
R | R | |||||||||||
color blindness | Eye dia | |||||||||||
ears | Hearing | L | ear dia | The doctors advice （Signature) | ||||||||
R | ||||||||||||
no | Sen of smell | no dia | ||||||||||
throat | ||||||||||||
Oral | Lip and palate历史上的关羽 | teeth | The doctors advice | |||||||||
Facial | other | |||||||||||
Surgery | Height | cm | Weight | kg | Skin | The doctors advice (Signature) | ||||||
Lymph | Thyroid徐州景点 | |||||||||||
Spine | Limbs | |||||||||||
Joint | Flatfoot | |||||||||||
Other | ||||||||||||
Internal Medicine | Blood Pressure | mmHg | Pul Rate | / min | The doctors advice （Signature） | |
Development and nutrition status | ||||||
Nervous and mental | ||||||
Lung and respiratory | ||||||
heart and vesls | ||||||
Abdominal organs | Liver | |||||
Spleen | ||||||
Other | ||||||
Chest radi’ography | Signature of Doctor: | |||||
Review comments | Signature of Review units: | |||||
Remarks | ||||||
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