The political view of primary school students is: students. The parent-child relationship is: Who is the father? Write down your name. Who is the mother? Write down your name. Not only children, but also sisters or brothers should fill in their names. 202 1 physical health records of primary and secondary school students

Basic information of students

Number:

Father's name:

Name:

Last name:

Ethnic groups:

Telephone number:

Date of birth:

Mother's name:

ID card number

Telephone number:

Grade:

Category:

Other guardians:

Delbert Mann

Weight:

Vision:

Telephone number:

Native place:

Current address:

Students' health history

Disease name

Yes or no

Disease name

Yes or no

Disease name

Yes or no

Remarks: Please truthfully fill in the physical health status of some students and accurately fill in the telephone number that can be contacted smoothly in the first time.

heart disease

hemopathy

tuberculosis

asthma

appendicitis

hyperthyroidism

diabetes

epilepsy

leukemia

Kidney disease

mental sickness

gastric ulcer

brain fever

canker

hepatitis

Mediastinal emphysema

sleepwalking

haemophilia

If the child suffers from one of the above diseases, please fill in the following table and attach a copy of the medical record on the back of this page.