XLS《执业医师健康体检表》

"医师执业注册健康检查表" "指定医院名称:",,

,,

,"体检日期","年月日",,

"姓名",,

,"性别",,

"出生日期",,

"近", "出生地",,

,,

,"民族",,

"照", "既往病史" "家族史" ,"甲状腺",,

,,

"脊柱",,

"医师签字", "外","淋巴",,

,,

"四肢",,

, ,"肛门",,

,,

"关节",,

, "科","泌尿生殖器",,

,,

,,

, ,"其他",,

,,

,,

, ,"血压",,

,,

,,

"医师签字", "内","神经及精神",,

,,

,,

, ,"肺及呼吸道",,

,,

,,

, ,"心脏及血管",,

,,

,,

, "科","腹部器官",,

,"肝",,

,,

,,

,,

"脾",,

,,

,"其他",,

,,

,,

, "胸部X线透视",,

,,

,,

"医师签字:",,

"心电图",,

,,

,,

"医师签字:",,

,,

,,

,,

,,

"五官科","眼","视力","左","矫正视力","左","其他眼疾",,

"医师签字:" ,,

,"右",,

"右",,

, ,"耳","听力","左","耳疾",,

,,

,,

,"右",,

,,

, ,"鼻及鼻窦",,

,,

,,

, ,"疾病",,

,,

,,

, ,"咽喉",,

,,

,,

, ,"其他",,

,,

,,

, "主要结果","(患有精神疾病、传染病发病期必须注明.

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,"体检单位盖章",,

, ,,

,,

,,

,,

,"主检医师签字: ,,

,,

,"年月日",,

, ,,

,,

,,

,,

,"主检医师签字:",,

,,

"填写日期:年月日",,

, ,,

,,

,,

,,

"注" "册" "机" "关" "意",,

,,

,"注册机关盖章:",,

, "见" ,,

,,

,"填报日期:年月日",,

, "注:","

1、表中内容请体检单位如实填写,不得涂改,不得弄虚作假. ,"

2、体检后此表交注册机关. ,"

3、X线、心电图、肝功报告单请贴在背面. ,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,

,,