Here is a physical examination form in English. Please help me translate it. Thank you! Sent from the school where I studied abroad.

Physical Examination certificate, Asia University

Asia University physical examination certificate

Full name: ______ Nationality: ________

Full name: Nationality:

Date of birth: ______ Sex: Male/Female_______

Date of birth: Gender: Male/Female

Address: ____________________________________

Address ：

1. Height: _____cm Weight: ________kg

Height: cm Weight: kg

Eye sight: ___(R) ______ (L) ____With glasses: _____(R) __ (L) ______

Visual vision: (right) (left) Wearing glasses: (right) (left)

Color: Normal /Abnormal

< p>Color Vision: Normal/Abnormal

Hearing: (R) Normal/Abnormal

Hearing: (R) Normal/Abnormal

(L) Normal /Abnormal

(Left) Normal/Abnormal

Urinalysis

Urine test

Protein - + ++ +++

Protein

Sugar - + ++ +++

Sugar

Urobilinogen - + ++ +++

Urobilinogen

HBs:

Hepatitis B surface antibody:

Antigen - +

Antigen

Antibody - +

Antibodies

Blood pressure: _____mmHg blood type: _____RH___-/+

Blood pressure: mmHg Blood type:

2. -ray: () direct () indirect

X-ray direct indirect

Please comment on condition of applicant's lungs, and give date of test.

Please comment The subject's lungs, and mark the test date

3. Please describe in detail if you find any disease, including chronic ones, or physical handicaps.

If you find any disease, including chronic ones, or physical handicaps. or physical impairment, please describe in detail

Please indicate past illnesses if applicant has had any.

Please indicate medical history, if any

4. I diagnose that the applicant's health and physical conditions are;

The subject's health and physical conditions are diagnosed as follows:

>( ) Excellent ( ) Good ( ) Fair ( ) Poor

Excellent, good, generally poor

I hereby certify the above diagnosis.

I hereby certify the above diagnosis.

Diagnosis

Physician's signature: ____________________________________

Physician's signature

Name of physician: ____________________________________

Physician's name

Name of the clinic: _________________________________________

Clinic Name

Date of examination: _________________________________________

Examination Date

This form must be completed by a physician .

This form must be completed by a physician