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"附件2:" "贵州省申请认定教师资格人员体检表" "(申请认定幼儿园教师资格人员专用) 编号:", "姓名",,

,"性别",,

"年龄",,

"婚否",,

"民族",,

"照片" "文化程度",,

,"职业",,

,"申请教师资格类别",,

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, "单位或住址",,

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"电话",,

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, "既往病史",,

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"受检者确认签字",,

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, "身份证号" "五官科","眼","裸眼视力","右",,

"矫正视力","右",,

"矫正度数","右",,

"医师意见:签名:" ,,

,"左",,

,"左",,

,"左",,

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"辩色力" ,"耳","听力","右",,

"耳疾",,

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"医师意见:签名:" ,,

,"左" ,"鼻","嗅觉",,

,"鼻疾",,

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,"咽喉",,

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"语音",,

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,"口腔","口腔唇腭",,

,"齿",,

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"医师意见:签名:" ,,

"口吃" "外科","身高",,

,"胸廓"医师意见:签名:" ,"体重",,

,"脊柱",,

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, ,"淋巴",,

,"甲状腺",,

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, ,"四肢",,

,"关节",,

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, ,"面部" "(续上表)" "内科","营养状况",,

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,"医师意见:签名:" ,"血压",,

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, ,"心脏及血管",,

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, ,"腹部器官",,

,"肝",,

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"脾",,

,"神经及精神",,

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, ,"其它",,

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, "胸部X线透视",,

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"医师意见:签名:" "化验检查","丙氨酸氨基转移酶(ALT)",,

,"淋球菌",,

"医师意见:签名:" ,"梅毒螺旋体",,

,"滴虫",,

,"外阴阴道假丝酵母菌(念珠菌)",,

,"其他",,

,"肝功能(ALT、AST)",,

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, ,"二对半",,

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, "体检医院结论","负责医师:年月日(单位盖章)",,

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, "备注:

1、若有既往病史,须在"既往病史"项中明确标明肝炎、结核、皮肤病、性传播性疾病精神病或其它,且需受检者签字确认.

2、对出现呼吸系统疑似症状者增加胸片检查项目.

3、滴虫、外阴阴道假丝酵母菌指妇科检查项目.",,

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