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  • Medical Report Form

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    makinch
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    ROYAL EMBASSY OF SAUDI ARABIA IN RABAT MEDICAL REPORT Name: ______________________________________________ Sex: _______ Age: _____________ Place and date of issue: ___________________ position applied for: ____________ Ensure photo is attached here. Signed and stamped across the front by your doctor.

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    Hak Cipta

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    ROYAL EMBASSY OF SAUDI ARABIA IN RABAT MEDICAL REPORT Name: ______________________________________________ Sex: _______ Age: _____________ Place and date of issue: ___________________ position applied for: ____________ Ensure photo is attached here. Signed and stamped across the front by your doctor.

    Hak Cipta:

    Attribution Non-Commercial (BY-NC)
    Unduh sebagai PDF, TXT atau baca online dari Scribd
    Tandai sebagai konten tidak pantas
    471 tayangan2 halaman

    Medical Report Form

    Diunggah oleh

    makinch
    ROYAL EMBASSY OF SAUDI ARABIA IN RABAT MEDICAL REPORT Name: ______________________________________________ Sex: _______ Age: _____________ Place and date of issue: ___________________ position applied for: ____________ Ensure photo is attached here. Signed and stamped across the front by your doctor.

    Hak Cipta:

    Attribution Non-Commercial (BY-NC)
    Unduh sebagai PDF, TXT atau baca online dari Scribd
    Tandai sebagai konten tidak pantas
    dari 2

    ROYAL EMBASSY OF SAUDI ARABIA IN RABAT

    MEDICAL REPORT
    PHOTO (1) Name: ____________________________________________________
    Sex: _______ Age: _____ Status: _________ Nationality: _____________
    Ensure photo is Passport No.: _____________ Place & date of issue: ___________________
    attached here. Position applied for: ______________________________________________
    Signed and stamped Dear Sir,
    across the front by Please arrange to examine the above mentioned candidate whether
    your doctor. he/she is fit for above mentioned position.

    Date: Recruitment Attaché

    History of any significant past illness including:


    1- Psychiatric and neurological disorders (Epilepsy, Depression …)
    2- Allergy
    ………………………………………………………………………………….
    ………………………………………………………………………………….

    MEDICAL EXAMINATION LAB INVESTICATIONS


    Type of medical exam: Results Type of Lab Invest: Results
    Eye vision R eye URINE
    - Sugar
    vision L eye - Albumin
    others R eye - Bilharziasis
    - others
    Ear R Ear STOOL
    L Ear - Helminthes
    CHEST X – RAY (2) - Bilharziasis
    SYSTEMIC EXAMINATION - Salmonella/Shigella
    -Blood Pressure - V Cholera
    - Heart - Others
    - Lungs BLOOD
    - Abdomen - Haemoglobin
    - Hepatitis
    OTHERS - Malaria Film
    * Hernia - Others
    * Varicose veins SEROLOGY
    - Extremities - Hiv Test
    - Skin -FBC
    VENEREAL DISEASES - HbsAg-Anti HCV
    -LFT
    - Clinical - Creatinine
    - Lab VDRL - Urea
    TPHA PREGNANCY TEST

    MENINGITIS VACCINATION
    (ACY W-135)
    Please produce a letter of
    certification or vaccination
    certificate for meningitis
    vaccination
    THE ABOVE IS A MEDICAL REPORT FOR:

    HE/SHE IS FIT FOR EMPLOYMENT

    SHE/SHE IS NOT FIT FOR EMPLOYMENT

    PHYSICIANS SIGNATURE: ______________________________________

    PHYSICIANS NAME (PRINT): ______________________________________

    THIS IS TO CERTIFY THAT THE

    ………………………………………………………………………………………......

    (Name of Medical Board)

    RECOGNISES DR. ……………………………………………………………………

    REGISTRATION NO. ………………………………………………………………...

    AND THAT HE IS QUALIFIED TO PERFORM THE MEDICAL


    EXAMINATION OF THE PERSON NAMED ON THE FORM

    ………………………………….
    (Signature)
    Seal/Cop of Medical Board

    …………………………………
    (Date)

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