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Yang Xiao Xiao
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Sh BA 18 HE Bh HE FOREIGNER PHYSICAL EXAMINATION FORM #%|SAT Mun pan Name #3) | O Male DEAE) Sex |@ dFemale | Birthday A121 2002 Se sh Present mailing address No.224, Block 4, Sig Road , Lashio tien Dap BE Nationality (or Area) Myanmar Hye ss Birth | Lashzg | alcodpe piace 3 MAA PSR: (ENE "we IR") Have you ever had any of the following diseases? (Bach item must be answered “Yes” or “No”) No OYes w Hi Bacillary dysentery ZINo OYes No OYes WICH Brucellosis ZNo Des HEE (9 — Typhus fever ANJLIRSEE — Poliomyelitis Fi Diphtheria MH ih Scarlet fever FL JA A Relapsing fever Di RAUT IE ‘Typhoid No OYes WAREVENT IE Viral hepatitis ZNo Yes No Ces PRWEB Puerperal streptococcus infection @No LYes woe and paretyphoid fever No C1Yes ‘WATHERIAHIMB — Epidemic cerebrospinal meningitis No OYes sBNo OYes RERA TARAS BIER SPE: (EM IE “A” wR” ) Do you have any of the following diseases or disorders endangering the public order and security? (Each item must be answered “Yes” or “No”) Son ‘Toxicomania: aaa, Mental confusion~ JAMO Psychosis: BREW Manic paychosi ai mK | Bi [WE 100/30 RE Height 166 cM | Weight 50 Kg Blood pressure mmig Pevtrme Normal [Nerina Normal [RE Normal we ee ord vos 8 Be Normal wen Normal [BP en, en nus Normal =, Normal -. NAD nae Norma | eS pteamal) |B “Naren Bw, Normal une HER Extremities | Norenal Nervous system | N orena| TE Spine Normal FHL, Other abnormal findings a8 ARB X ECC EER Klose (Pithteate a A) Chest X-ray exam (attached chest X-ray report) ele te et ‘ps6 SALE) AD rabies Nee (attached test report of AIDS, Syphilis ete) FR BUIB AB PURE DIE APE BAS AE MB BEI: ‘None of the following diseases of disorders found during the present examination. Ra Cholera feat ‘Venereal Disease ‘BIAMI —Yellow fever ‘VK Lung tuberculosis RE Plague Yes rua ams Nes JRL Leprosy HEHE Psychosis a R AB LSS HE ‘Suggestion Official Stamp vem: AM Ses ee cian Dae 4/4/2003 ‘Medical Superintendent Senior Consultant E.N.T Kaung Khant H Lashio, N.S.S, Myanmar SAMA-2882

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