ion and Chest X- ray 身高(Height) 体重(Weight) 血压(Blood Pressure) cm Kg/ mmHg 检查日(Date of Chest) // 1.胸部 X线检查□2.痰结核菌检查□3.结核菌素试验□4.血液检查□ I. 结果(1) (Result): 非特异所見(Non - specific) □非活动性结核(Inactive TB) □活动性结核(Active TB) □→3- 1.传染性(Infective) □,非传染性(Non - infective) □→3- 2.感受性结核(Drug - sensitive TB) □,多剂耐性结核(MDR TB) II. 治疗结果(2) (Treatment es) - For person who has TB history 治疗中(Under treatment) □,完治(Cured) □完了(Completed Treatment) □治疗失败(Failed) □治疗漏落(Defaulted) □对上述项目进行了检查。 The examination was performed as above. 执照号码(License No.) :/ 医生姓名(Name of Physician): ( 签章) 检查结果(Summary of the examination) 对受检者停留的意见(Remarks about examinee ’s domestic stay) 仔细检查的必要性(Additional close examination) 以上是对受检者健康状态的结果与评估。 We hereby certify that the examinee's heath status is assessed as above. dd.mm.yyyy. ○○○○医院( 印章)
全文预览
