ressure) Р cm Kg / mmHg Р Р 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□Р I. 结果(1) (Result): Р 非特异所见(Non-specific) □Р 非活动性结核(Inactive TB) □Р 活动性结核(Active TB) □Р → 3-1. 传染性(Infective) □, 非传染性(Non-infective) □Р → 3-2. 敏感性结核(Drug-sensitive TB) □,耐多药结核(MDR TB) Р Р II. 治疗结果(2) (Treatment es) - For person who has TB history Р 治疗中(Under treatment) □Р 治愈(Cured) □Р pleted Treatment) □Р 治疗失败(Failed) □Р 治疗中段(Defaulted) □Р 对上述项目进行了检查。Р The examination was performed as above. Р Р 执照号码(License No.): / 医生姓名(Name of Physician): (签章) Р Р 检查结果Р (Summary of the examination) Р 对受检者停留的意见Р (Remarks about examinee’s domestic stay) Р 仔细检查的必要性Р (Additional close examination) Р 以上是对受检者健康状态的结果与评估。Р We hereby certify that the examinee's heath status is assessed as above. Р Р dd.mm.yyyy. Р ○○○○医院(印章)
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