Page 17 - demo

PANDUAN PENDAFTARAN PELAJAR BAHARU PASCASISWAZAH

HEALTH EXAMINATION
* TO BE COMPLETED BY THE MEDICAL OFFICER

PHYSICAL CONDITION
Height cm
Weight kg
Pulse /min

Blood Pressure

Please tick (√) in the appropriate box Normal Abnormal
Skin
Lung
Heart
Abdomen
Teeth
Ear
Nervous System
Musculoskeletal System

EYE TEST Normal Abnormal
Without Glassess/Contact Lenses
With Glassess/Contact Lenses
Colour Blind

URINE TEST (Please tick (√) in the appropriate box) Yes No
Urine Sugar
Albumin
Blood/RBC
Drugs
Pregnancy

X-Ray Report (Not Necessary unless requested by examining Medical Officer)

X-Ray No.

X-Ray Report :

Page 2 of 4