境外人员体格检查记录(共3页).doc

精选优质文档-倾情为你奉上境外人员体格检查记录PHYSICAL EXAMINATION RECORD FOR FOREIGNER姓名Name性别Sex 男Male 女 Female出生日期Date of Birth Day/Month/Year 照 片 Photo现在通讯地址Present address血型Blood type 国 籍Nationality出生地址Birth Place过去是否患有下列疾病：(每项后面请回答“是”或“否”)Have you ever had any of the following diseases? (Each item must be answered “Yes” or “No”)斑疹伤寒 Typhus fever No Yes 菌 痢 Bacillary dysentery No Yes小儿麻痹症 Poliomyelitis No Yes 布氏杆