They sent me the form-here it is. My doctor has given me a quote of £150, and promptly disappeared on holiday until the 14th. The £150 doesn't seem over the top to me considering how much equipment is needed to do such a medical. Now, my doctor doesn't even have an X-ray machine, God knows how he will fill in this form. I am expecting the Chinese to say I have to have another medical when I arrive, even though they have assured me it will not be necessary. The fao tells me I am aggressive because I answered, you may tell me that but I don't necessarily believe you. I said to her, firstly do you undertake to reimburse the £150 and moreover as you are so confident that the authorities will not demand another medical, I want you to undertake to pay for the one in China that I will not need to undergo? She reluctantly agreed-so right from the outset before I even start the job we have bad feelings.

外国人体� �检查记录
PHYSICAL EXAMINATION RECORD FOR FOREIGNER
姓 名
Name

性别 □男Male
Sex □女Female
出生日期 年 月 日
Date of Birth y. m. d.
照片
photo
(put hospital seal across the photo)
现在通讯地址
Present mailing address

血型
Blood Type

国籍
Natio-nality

出生地
Birth Place

过去是否患有下列疾病：（每项后面请回答“否”或“是”）
Have you ever had any of the following diseases? (Each item must be answered“Yes”or“No”)
斑 疹 伤 寒 Typhus fever □No□Yes 细菌性痢疾 Bacillary dysentery □No□Yes
小儿麻痹症Poliomyelitis □No□Yes 布氏杆菌病Brucellosis □No□Yes
白 喉 Diphtheria □No□Yes 病毒性肝炎 Viral hepatitis □No□Yes
猩 红 热Scarlet fever □No□Yes 产褥期链球菌 Puerperal streptococcus □NO□Yes
回 归 热 Relapsing fever □No□Yes 感 染 infection □No□Yes
伤寒和副伤寒 Typhoid and paratyphoid fever □No□Yes
流行性脑脊髓膜炎 Epidemic cerebrospinal meningitis □No□Yes
是否患有下列危及公共秩序和安全的病症：（每项后面请回答：“否”或“是”）
Do you have any of the following diseases or disorders endangering the public order and secure?
(Each item most be answered “Yes”or“No”)
毒物瘾 Toxicomania………………………………………………………………………………□No□Yes
精神错乱Mental confusion ………………………………………………………………………□No□Yes
精神病Psychosis：躁狂型 Manic psychosis……………………………………………………□No□Yes

妄想型 Paranoid psychosis…………………………………………………□No□Yes

幻觉型 Hallucinatory psychosis……………………………………………□No□Yes
身 高/Height (厘米/ cm)
体 重/ Weight (公斤/ kg)
血压/pressure Blood(毫米汞柱/mmHg)
发育情况Development
营养情况Nourishment
颈部Neck

视 力
Vision
左L

右R
矫 正 视 力
Corrected vision
左 L

右R
眼Eyes
辨 色 力/Color sense
皮肤/Skin
淋巴结/Lymph nodes
耳/Ears
鼻/Nose
扁桃体/Tonsils
心/Heart
肺 /Lungs
腹部/Abdomen
编号：42 （19×27cm）

脊柱/Spine
四肢/Extremities
神经系统/Nervous system
其他所见
Other abnormal findings
胸部X线检查/Chest X-ray exam

心电图/ECG

化验室检查(包括艾滋病、梅毒血清学诊断)/Laboratory Exam (HIV, Syphilis Serodiagnosis)
附上对以下项目的化验室报告：Please attach the results and data sheets for the following items:AIDS.,Syphilis,ALT.,AST.,T-BIL.,and HBsAG.
未发现患有下列检疫� 染病和危害公共健康的疾病：
None of the following diseases or disorders found during the present examination.
霍 乱 Cholera 性 病 Venereal Disease
黄热病 Yellow fever 开放性肺结� �Opening lung tuberculosis
� 疫 Plague 艾 滋 病 AIDS
麻 风 Leprosy 精 神 病 Psychosis

意 见 检查单位盖�
Suggestion Official Stamp

医师签字 日期
Signature of physician Date