Items requiring physical examination are as follows:
Physical examination form for teacher qualification applicants
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Last name, first name, gender, age and nationality stickers
mutually
piece
place
National identity card number
Work unit occupation
Mailing address and telephone number
Infectious diseases with a past history
Psychological and psychiatric history
other
(The above blanks shall be truthfully filled in by the applicant)
five
police officer
The vision correction degree of the naked eye vision correction department is correct.
Doctor's opinion:
Signature:
the left side
Color-discriminating ophthalmopathy
Hearing left ear meter and right ear meter
Nose, olfactory nose and sinuses
Face and throat
Oral labial palatine teeth
other
Outside
Section height cm weight kg
Doctor's opinion:
Signature:
Lymphatic spine
Limb joint
Skin neck
other
inside
Branch blood pressure
Doctor's opinion:
Signature:
nutritional status
Heart and blood vessels
respiratory system
nervous system
Abdominal organ liver
spleen
other
Laboratory examination (with laboratory test sheet) blood routine, liver function routine and urine routine.
Chest fluoroscopy
Doctor's signature:
Physical examination conclusion
Signature of Chief Examiner:
date month year
Medical examination hospital opinion
Medical examination hospital seal
date month year