The problem of going abroad for medical examination

☆ Please fill in the personal information and parts A and D in the above table before attending the physical examination [fill in the above personal details, and fill in parts A and D before attending the physical examination];

Please complete part b of the form in the presence of a doctor.

coroner

☆ Please mark the form and photos above (please don't smear photos) to prove that the inspector is indeed the applicant, including the date of verification;

☆ Check the valid passport and record the passport number (next to the photo);

☆ Assist the applicant to complete Part B of the form;

Complete part c of the form.

Blood tester

Please mark the bottom of the form and photos (please don't smear photos) to confirm that the inspector is the applicant, including the date of verification.

Official use [office use only]

Part A-Details of the applicant [Part A-Details of the applicant]] Please ask the applicant to complete this part before attending the physical examination; Please fill in clearly in English capital letters with a pen. [To be completed by the applicant before attending the physical examination. Please use a pen.

Write neat English in print. ]

1. Full name [your full name], last name [last name] and first name [first name];

2。 Address [your residential address] and postal code [zip code];

3。 Daytime telephone number [Daytime telephone number], country code [country code], area code [area code] and number [number];

4。 Gender [gender], male [male], female [female];

5。 Date of birth [date of birth], day [day], month [month], year [year];

6。 Work or activity planned in Australia (roughly what to do) [occupation/activity planned in Australia];

7。 What is your work in the last five years (that is, the work you did before) [moved in before the last five years];

8。 Which country did you live in in the past 5 years [country where you lived in the past 5 years];

9。 [If you live in Australia]:

How long have you been here? ] year [year] month [month];

☆ What kind of visa do you hold at present?

10。 How long are you going to stay in Australia?

9734 [Permanent] (including non-immigrant application) [including non-immigrant application];

☆ Temporary [temporary]: How long? [How long? ] year [year], month [month];

1 1。 What kind of visa do you apply for? What kind of visa did you apply for? ];

12。 Have you applied to the relevant office of the Immigration Bureau? [Have you submitted an application to the Office of the Immigration Department?

Multiculturalism and Indigenous Affairs? ]

☆ No [No] Which office do you want to apply for? [Which office are you going to apply to? ];

☆ Which office is it? [Which office? ];

13。 Are you [are you]:

☆ Children adopted by Australian residents? [Children adopted by Australian residents? ]

Refugee children without guardians? [Unaccompanied minor refugee children? ]

☆ Refugees who have lived or are living and camping? [Refugees who have lived or are living in refugee camps? ]

14。 In Australia, you will: [In Australia, you will:]

☆ Class or teaching [Class or teaching? ]

☆ Join the health protection organization [participate in medical care].

☆ Join child protection or orphan rescue [participate in child care/nursery? ]

15。 You used to: [You used to]

☆ An operation;

☆ Hospitalization for some reason [hospitalization or hospitalization for any reason];

☆ Tuberculosis or chest X-ray abnormality, hemoptysis, or contact with tuberculosis patients [tuberculosis or chest abnormality]

X-rays, or have coughed up blood or had contact with tuberculosis patients];

☆ Convulsion or epilepsy [convulsion, seizure or epilepsy];

☆ Anxiety, depression and nervousness are the main symptoms that need treatment.

☆ Need to be hospitalized for mental illness, or see a psychologist [hospitalized for mental illness or consult a psychologist];

Hypertension, heart disease, dyspnea or chest pain. Hypertension, heart disease, dyspnea and/or chest pain? ];

Pain in the back, neck or any joint;

☆ Stomach pain, dyspepsia or heartburn [stomach pain, indication or heartburn];

☆ An infectious disease lasts more than two weeks [an infectious disease lasts more than two weeks];

☆ Kidney or bladder problems [kidney or bladder diseases or complaints];

☆ Diabetes or urine sugar;

☆ Any disease that lasts for more than two weeks, or periodic disease not mentioned above [any disease, disease or medical condition that lasts for more than two weeks, or recurrence not mentioned above];

☆ Have received any medical, surgical or mental illness treatment in the past five years [have received any medical, physical, psychological or other treatment in the past five years];

16。 Please answer the following questions: [Please answer the following questions] (For any question that answers "Yes", all detailed relevant materials must be provided, including the date).

☆ Are you taking any medicine or receiving treatment?

☆ Have you ever been addicted to drugs or taken drugs illegally [have you ever been poisoned or taken drugs illegally];

Do you drink? How much do you drink? ];

☆ Are you smoking or have you ever smoked? How much do you smoke? how much is it? ];

☆ Do you have physical or mental disabilities that affect your life or self-care [do you have physical or mental disabilities that may affect your earning ability].

Life or take care of yourself];

Do you receive a pension for medical reasons?