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Physical Examination Form

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Ghulam Abbas Lashari
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2K views

Physical Examination Form

pe

Uploaded by

Ghulam Abbas Lashari
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF or read online on Scribd
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dh A HK He OE FOREIGNER PHYSICAL EXAMINATION FORM. ee |CHOLAN =| teat | gmc | EMT Io cae sone] ABBAS | Se | Female | Binhiey Sakkat HR ap ST vood Sala Nicaea [Sindhi Palle tor won Miepec Mabe ime an Mir ma Naticeniy |Pukislana | “ninth [S'NGH | aoodeype| Cave (cere) piace | Pakistan " AERA ITPRER: OTUT IAIN A" we Have you ever had ary othe following cseses? (Each Rem must be anowered "Yes" o¢No") HE GE tohsine Sho Os tay day hp Ce ANJLMIEE Poliomyelitis No OYes —-AIGATIN—rcelloss No Yes WR Diteria—SINo Yes FARAERFAR —_VirlDepais No Lives QL Bh Seatet fever SINo DYer — PRINARERR Puerperal streptococci infin HL FL HS Relasing fever SIN Os 6 MO No Yes AHA — Typhoid paraypidtove — hy Oe AUETERMTHHIEMLA— Hidemiccorbrspan meng Avo Ver ESSHMEAROPREROR: (PARMNAS A&E) Dp you hive any of he felowing diseases or disarden endangering te public order and sccrity? (Each te ust be answered ~Yes" oF "Nay wom hyo Ye me ore AWA Pci: BALSL Nan pve he Ove Site ean payhs= wt Oe ERRML Haltehuegernnsosnnen he Oe ae mk | he ae ak RE Folk 39) eM | Weigh 0) Ke | Bloat pessue (20/7, stg RAMS. we am Deveopnent Novena) — | Nasrishent Novena) | Neck Nowmal, Wn zt oe | ERA cas a iim inkl Conmiedvshn 3t8 be Nowmal wen RR wee Goeersave Norn _| ke Noval tympani Nowe) y a rd ts Nowmo\ Nae Noval tons Noverel = % am ten Noval fone Novrnal Ahioes Novenaate sine | Normal, EAH Exvemiion "Nervous este Normal dormal, (Oder aboeemal findings zane [No ony abonovmnelibies Srndtir Aclected * mera 8) (Chet Xray exam (tached est Xray p00) mae Noval ecco = |Ik ve ou nowmel Lamts, seme azarae. Labontory ex (cached teat report of AIDS, Syphilis ee) waganane |... Dedicated RELA TOELEM EEE RRO: ‘Nowe ofthe following diseases of dordesfoard during the preset examinaten, Ma Cholers ‘YEA —Vencreal Disease: BBM Yelow over MRE Ling bec WUE Plague Ree AIDS WR Leprosy MUR Psychosis aol amy acute oX etme Oficial Sump am Date 20012086

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