MEDICAL REPORT
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Last Name : …………………………. Height : ………….Ft………..In………. Sex : …………………………………… Age : ……….. Passport No : ……………………… Position applied for : …………………… History of any significant post illness including: 1.) Psychotic and neurological disorders (Epilepsy. depression. Schizophrenia…… 2.) Allergy 3.) Others |
First Name :………………. Wt ……. Lbs ……… Status : …………….. Nationality : ………… Place of issue : ……….. Recruiting Agency……………………. |
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Signature of Examinee ……………………….
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MEDICAL INVISTIGATONS
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TYPE OF MEDICAL EXAMINATIONS |
RESULTS |
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Rt EYE …………. ………. Lt |
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Rt EAR ………………….. Lt |
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CARDIO-VASCULAR B.P………………
HEART……………. |
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LUNGS……………
CHEST X-RAY |
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ABDONEN
OTHERS |
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HERNIA |
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VARICOSE VEINS |
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EXTRENITIES |
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DEFORMITIES |
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SKIN |
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VENEREAL DISESES CLINICAL |
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C N S |
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PSYCHIATRY |
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LABORATORY INVISTIGATONS
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TYPE OF AB INVISTIGATONS |
RESULTS |
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URINE SUGAR ALBUMIN BILHARZIASIS (IF ENDEMIC)
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STOOL ROUTINE 1. HELMINTHES 2. GUARDIA 3. BILHZIASIS (IF ENDAIC CULTURE) 4. SALMONELLA SHEGLLLA V CHOLERA (IF ENDEMIC)
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BLOOD HAEMOGLORIS THICNFILM FOR 1. MALARIA 2. MICRO FILARIA
SEROLOGY 1. F B S 2. L E T S 3. CREATINNE
EMSA 1. HIV 1.2 TEST 2. HBs Ag 3. Anti HCV
VDRL TPHA (IF VDRL POSITIVE)
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PREGNANCY TEST |
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Notes about medical and laboratory investigation
Dear, Sir,………………………………………….. Mentioned above is the medical report for Mr. / Mrs ………………………………………………………………………………………. He / She is fit For the above mentioned job Unfit Chief Physician
Stamp Name : ……………………. Signature :
(1) Stamp of the medical center on the photo and application
(2) Chest : Free of pathological changes the medical report and x-ray should be submitted to the health authorities in GCC countries.