Scribd Logo
Încărcați

Bine ați venit la Scribd!

  • Medical Exam Report

    Încărcat de

    Syafaatul ULa
    116 vizualizări1 pagină
    Medical

    Drepturi de autor

    © © All Rights Reserved

    Formate disponibile

    DOCX, PDF, TXT sau citiți online pe Scribd

    Vi se pare util acest document?

    Este necorespunzător acest conținut?

    Raportați acest document
    Medical

    Drepturi de autor:

    © All Rights Reserved
    Descărcați ca DOCX, PDF, TXT sau citiți online pe Scribd
    Indicator pentru conținut neadecvat
    116 vizualizări1 pagină

    Medical Exam Report

    Încărcat de

    Syafaatul ULa
    Medical

    Drepturi de autor:

    © All Rights Reserved
    Descărcați ca DOCX, PDF, TXT sau citiți online pe Scribd
    Indicator pentru conținut neadecvat
    din 1

    DINAS KESEHATAN KABUPATEN BINTAN

    UPT PUSKESMAS TELUK SEBONG


    KLINIK PARIWISATA LAGOI
    Bintan Resort Jl. Kota Kapur Lagoi 29155 Tlp.0770 - 692023
    MEDICAL EXAMINATION REPORT

    GROUP OF WORKER : .................................................. REPORT NUMBER : ..................................................


    EXAMINATION ORDER : 1. INITIAL EXAMINATION DATE OF EXAMINATION : ..................................................
    2. FOLLOW UP I
    3. FOLLOW UP II

    COMPANY : .................................................. Laboratory & other tests


    Name : .................................................. Haemoglobin : ..................................................
    Gender : .................................................. White Blood Cell : ..................................................
    Marital Status : .................................................. Malaria : ..................................................
    Place & Date Of Birth : .................................................. Urine Test : ..................................................
    Past Medical History : .................................................. Stool Culture : ..................................................
    Previous Surgery : .................................................. Chest X-Ray : ..................................................
    Widal Test : ..................................................
    PHYSICAL EXAMINATION Typhoid Vaccination : ..................................................
    General Appearance : ..................................................
    Weight (Kg) : .................................................. REMARKS :
    Height (cm) : .................................................. .......................................................................................................
    Blood Pressure (mmHg) : .................................................. .......................................................................................................
    Heart Rate Per Minute : .................................................. .......................................................................................................
    Respiration Rate Per Minute : .................................................. .......................................................................................................
    Head & Neck : .................................................. .......................................................................................................
    Ears/Nose/Throat : .................................................. .......................................................................................................
    Eyes : .................................................. .......................................................................................................
    Visus : .................................................. .......................................................................................................
    Colour Blindness (ISHIHARA) : ..................................................
    RESULT : ..................................................
    Head & Neck : ..................................................
    Chest /Heart / Lung : .................................................. Examined by : ..................................................
    Abdomen : ..................................................
    Rectal & Genital : .................................................. This Certificate Issued By : ..................................................
    Extremities : ..................................................
    Central Nervous System : .................................................. Date Of Issue : ..................................................
    Muscle Skeletal System : ..................................................

    PERSONAL HYGIENE Signature &


    Hair / Scalp : .................................................. Stamp
    Oral Capacity : ..................................................
    Arms / Fingers / Nails : ..................................................
    Skin : ..................................................

    S-ar putea să vă placă și