中英文对照医院体检表(出国办签证所用)

英国签证申请人结核筛查体检登记表UK Pre-Departure Tuberculosis Screening Programme=================================================================================姓名：性别： □男 □女 出生日期： （日/月/年） 国籍： 护照号码： 护照有效期： 签证类型： 同行11岁以下儿童人数（不含11岁）： 电话号码：中国居住地址（请用英文填写）：英国联系地址（请用英文填写）： 英国邮政编码：请如实回答下列问题：请仔细阅读表格反面《知情同意书》并签字确认。

申请人申明：本人已了解下述情况：•在申请入境英国前，我必须接受肺结核筛查（X光检查），并可能进一步接受痰液检查；•如果胸部X光检查发现异常，医师将对我进行单独询问并告知我进一步检查的步骤；•如果我的胸部X光检查结果为异常，无论是新发病灶或陈旧病灶，只要该病变提示结核可能，或者存在其他临床表现提示结核可疑，我都必须提供三次痰液标本供结核菌涂片和培养检测。

痰培养检查结果需10周时间，我对此表示接受。

•如果需要进行痰液检查，我应在胸部X光检查后7天内返回进行留痰，采痰需在连续3天早晨进行。

如果不能在7天内返回留痰，我将无法获得签证用“医学证明”。

•如果痰涂片或培养显示有结核杆菌存在，我须接受抗结核治疗，治疗费用将由我自行承担。

我还应告知承担抗结核治疗的医疗机构，与我密切接触的家庭成员可能需要进行相关的结核病评估。

•我有权拒绝接受结核病筛查或抗结核治疗，但该行为可能影响申请赴英签证。

•医务人员对于是否给予医学证明具有最终决定权，我对此表示接受。

女性申请人：所有的女性申请人都将被询问末次月经时间以便确定是否妊娠。

•如果我已怀孕，以下几个检查方案可供我选择：⑴穿上铅保护裙后进行胸部X光检查；⑵将胸部X光检查（和结核病筛查）推迟到分娩后再进行；⑶连续留三次痰液标本用于实验室检查。

体检项目英汉对照表alpha-fetoprotein (AFP) 甲胎蛋白（AFP）Blood and urine, 血常规,尿常规,blood routine 血常规，blood viscosity, 血粘度,brain transcranial Doppler flowmetry, 经颅多普勒脑血流测定,C12 protein chip (complete tumor detection) C12蛋白芯片（肿瘤检测全套）carcinoembryonic antigen (CEA), 癌胚抗原（CEA）cervical smears, 宫颈涂片chest (situated) 胸片（正位）chest, 胸片cholesterol, 胆固醇，color Doppler ultrasound heart, 心脏彩超,colposcopy 阴道镜检查creatinine, 肌酐，detection of vascular atherosclerosis 血管动脉硬化检测dual-energy X-ray bone density screening, 双能X射线骨密度检查electrocardiogram, 心电图，ENT, 五官科，EYE: color blindness inspection, 色盲检查,EYE: digital fundus photography, 数码眼底摄影,EYE: fundus examination, 眼底检查,EYE: slit lamp examination, 裂隙灯检查,EYE: vision screening, 视力检查,EYE:intraocular pressure checks), 眼压检查fasting blood glucose, 空腹血糖，Fe (ferritin), beta - HCG (human chorionic gonadotropin), HGH (growth hormone), the CA-125 (ovarian), the CA-15-3 (breast), Fe（铁蛋白）、β-HCG（人绒毛膜促性腺激素）、HGH（生长激素）、CA-125（卵巢）、CA-15-3（乳房）、glycated hemoglobin, 糖化血红蛋白,GPT, 谷丙转氨酶，Gynecological basic examination 妇科基础检查HAV antibody HAV – IgM 甲肝抗体HAV-IgMHelicobacter pylori Detection 幽门螺旋杆菌检测hepatitis B surface antigen 乙肝表面抗原hepatitis C HCV antibody-Ab electrolyte detection, 丙肝抗体HCV-Ab电解质检测Internal, 内科，Isotope carcinoembryonic antigen (set) 同位素癌胚抗原（全套）Leucorrhea conventional, 白带常规Lipid complete, 血脂全套,liver function set of 11, 肝功能全套11项,PSA prostate antigen PSA前列腺抗原ovarian (CA125) 卵巢（CA125）prostate bladder B ultrasound 前列腺膀胱B超protein chip C12 C12蛋白芯片serum glucose, 空腹血糖,stomach Helicobacter pylori (antibody), 胃幽门螺旋杆菌（抗体）super microscope Subhealthy detection, 超高倍显微亚健康检测,surgery, 外科，the high-resolution microscope detection (a blood disease detection) 高分辨显微镜检测（一滴血疾病检测）three renal function, 肾功能3项,trace elements 微量元素Transvaginal Ultrasound 阴道彩超triglyceride, 甘油三脂，tumor detection screening (qualitative), 肿瘤筛选检测（定性）cardiovascular function diagnosis, 心血管功能诊断two pairs of semi - hepatitis B 乙肝两对半ultrasound (splenorenal major abdominal), B超（肝胆胰脾肾），unmarried female B ultrasound - (uterus, annex), 未婚女性B超（子宫，附件）urea nitrogen, 尿素氮，urine routine, 尿常规，whole blood viscosity 5. 全血粘度等5项,医院常用中英文对照汇编－供查询公共空间大厅Hall中药局ChineseMedicinePharmacy公用电话PublicTelephone/PayPhone/Telephone/PublicPhone日常生活训区DailyActivityTraining日间门诊ClinicArea日间院AdultDayCareCenter日间照护DayCareCenter出院室DischargeOffice加护病房IntensiveCareUnit(ICU)打卡刷卡区ClockIn/Out民众意箱Suggestions各科门诊Out-PatientDepartments(OPD)早产儿室PrematureBabies自动提款机ATM住院室Admissions佛堂BuddhistPrayerRoom吸烟区SmokingArea志工服务台VolunteerServices志工室Volunteers衣室DressingRoom巡箱PatrolBox夜间门诊EveningClinic居家护HomeHealthCare居家护室HomeHealthCare服务台(询问处)Information注射室Injections治室TreatmentRoom社福卫教室SocialWorkandHealthEducation门诊大厅OutpatientHall门诊注射室OutpatientInjection门诊部Out-patient门诊满意调查回收意箱SuggestionBox门诊检验OPDLaboratory待产室LaborRoom急诊暂观察室ERObservationRoom恢室RecoveryRoom候诊区WaitingArea员工意箱Suggestions晒衣场ClothesDrying气喘卫教室AsthmaHealthEducationRoom消毒室Sterilization消毒锅区EquipmentSterilization病房Ward病毒室ViralLaboratory健儿门诊WellBabyClinic医院常用中英文对照汇编公共空间健保卡换卡服务中心NationalHealthInsuranceCardRenewal 健检中心PhysicalExaminationCenter健检室PhysicalExamination产后妇中心PostpartumCareCenter产后护之家PostpartumCare发烧筛检站FeverClinic诊室ConsultingRoom新生儿病房NeonatalWard隔检疫舍QuarantineHouse团体治室GroupTherapy语言治室SpeechTherapy药处MedicineReceiving卫教公布HealthEducationBulletinBoard卫教室HealthEducationOffice婴儿室BabyRoom检查室ExaminationRoom总层引FloorPlan转诊中心ReferralCenter药物谘询DrugInformation药库DrugStorage护之家NursingHome台Terrace接待,服务及休闲区水间Kitchen/Drinkingwater/HotWater 饮水机DrinkingFountain配膳间MealChecking发厅Barbershop美发(容)院BeautySalon商店街ShoppingArcade员工餐厅StaffRestaurant/Cafeteria餐厅Restaurant西餐厅WesternRestaurant贵宾室GuestRoom/Reception会客室ReceptionRoom休息室Lounge家属休息室Lounge图书室Library阅览室ReadingRoom放映室ProjectionRoom影印室CopyRoom育婴室NurseryRoom/MotherandBabyRoom哺乳室NurseryRoom值班室DutyRoom驻警室Security警卫室SecurityRoom接待,服务及休闲区停管中心ParkingServiceCenter调室DispatchRoom司机室/司机调室Drivers‘Lounge值日室DutyRoom值班休息室DutyOffice医师休息室Physicians‘Lounge宿舍Dormitory儿童游戏场RecreationArea医器材贩卖部MedicalSupplyDispensary爱心椅CourtesyWheelchairs椅借用区MovableBeds政单位人资源部HumanResourcesDepartment人事室PersonnelOffice人事组PersonnelSection人事处DepartmentofPersonnel公安室IndustrialSafetyOffice工务科Maintenance公关室PublicRelationsRoom(Office)文卷室DocumentationandArchivesOffice主计室ComptrollerOffice出纳室Cashier出纳课CashierSection民诊处CivilianAdministrationDivision企划室StrategyPlanningOffice企划组PlanningSection企划组PlanningandManagementSection企划管部PlanningandManagementDivision安全卫生室LaborSafetyandHygiene成本执组CostManagementSection收发室MailRoom政副院长室AdministrativeDeputySuperintendent 政管中心Administration住/出/转院Admission/Discharge/Transfer住院病组InpatientRecordsUnit兵役复检室MilitaryServiceExamination批价柜台Cashier系统组SystemEngineeringSection防台中心TyphoonEmergencyCenter社会服务室SocialWorkerRoom社区副院长室CommunityDeputySuperintendent社会服务科SocialServiceSection门诊病组OutpatientRecordsUnit保险作业组InsuranceDeclarationSection急诊批价ERCashier科主任办公室Dept.ChiefOffice政单位疾病分析组DiseasesClassificationUnit 病室/组MedicalRecordsRoom/Unit/Section医院常用中英文对照汇编门诊组OutpatientUnit/Section住院组InpatientAdmissions秘书室AdministrationOffice院长室Superintendent挂号柜台Registration采购组ProcurementSection教学组TeachingSection工安全卫生室OccupationalSafetyOffice安室WorkSafetyOffice安课LaborSafetySection程式组ApplicationProgrammingSection勤务中心ServiceOffice感染控制委员会InfectionControlCommission会计室AccountingOffice会计组AccountingSection资讯管部InformationManagementDivision稽核组AuditingSection卫材供应组MedicalSupplySection档案室Archives营养部Food&NutritionDepartment总务室GeneralAffairsOffice总务组GeneralAffairsSection医品组QualityAssuranceSection医勤组MedicalServiceSection医学工程室MedicalEngineeringOffice医副院长室MedicalDeputySuperintendent药剂科主任室PharmacyChief床科部中医科ChineseMedicine中医科-内科ChineseInternalMedicine中医科-针灸科ChineseAcupuncture小儿科Pediatrics小儿科-心脏PediatricCardiology小儿科-外科PediatricSurgery小儿科-心肺PediatricCardiopulmonary小儿科-感染PediatricInfectiousDiseases小儿科-胃肠PediatricGastroenterology小儿科-眼科PediatricOphthalmology小儿科-神经科PediatricNeurology小儿科-遗传科PediatricGenetics小儿科-预防注射PediatricVaccinations床科部小儿科-一般门诊Pediatrics医院常用中英文对照汇编小儿科-青少门诊AdolescentHealth小儿科-过敏免疫风湿科PediatricAllergyImmunology 小儿科-血液肿瘤科PediatricHematology&Oncology 小儿科-科PediatricUrology小儿科-内分科PediatricEndocrinology小儿科-重症医学科PediatricIntensiveCare新生儿科加护病房NewbornICU小儿加护病房PediatricICU儿童急救加护医学科PediatricEmergencyandCriticalCareMedicine 小儿心肺功能室PediatricPFT优生保健科PerinatalGenetics内科InternalMedicine内科-一般门诊InternalMedicine:General内科-日间化学治DayChemotherapy内科-胃肠科Gastroenterology内科-胸腔科PulmonaryMedicine内科-肾脏科Nephrology内科-内分科Endocrinology内科-内分暨代谢科EndocrinologyandMetabolism内科-心脏(血管)内科CardiologyDept.内科-血液肿瘤科HematologyandOncology内科-人医学门诊Geriatrics内科-过敏免疫风湿科Rheumatology/Immunology/Allergy内科-神经Neurology内科加护病房MICU内科-肝胆胰内Hepatic-biliary-pancreaticMedicine内科-感染科InfectiousDisease牙科Dentistry(Dental)Dept.家庭牙医科FamilyDentistry牙科-特别门诊DentalSpecialtyClinic牙科一般门诊(初诊)DentalClinic-InitialVisit牙科复诊(约诊)DentalClinic-AppointmentOnly口腔颚面外科OralMaxillo-facialSurgery口腔病诊断科OralPathology齿颚矫正科Orthodontics儿童牙科PediatricDentistry牙周病科Periodontics补缀科Prosthodontics外科Surgery外科-小儿PediatricSurgery外科-骨科Orthopedics外科-神经Neurosurgery外科-手外科HandSurgery外科-消化系GastrointestinalSurgery外科-一般门诊Surgery-GeneralClinic床科部外科-大肠直肠Colo-rectalSurgery外科-整形PlasticSurgery医院常用中英文对照汇编外科-甲腺乳腺ThyroidandBreastSurgery外科-乳房BreastSurgeryClinic外科-心脏CardiacSurgery外科-心脏血管CardiovascularSurgery外科-胸腔ThoracicSurgery外科-美容外科CosmeticSurgery外科-肝胆HepaticSurgery外科-肝胆胰外Hepatic-biliary-pancreaticSurgery 外科-重建整形Plastic&ReconstructiveSurgery外科-胃肠及一般Gastroenterology&GeneralSurgery 骨外伤科OrthopedicTraumatology外科加护病房SurgeryICU皮肤科Dermatology皮肤科-一般门诊Dermatology-GeneralClinic皮肤科-职业性皮肤病OccupationalDermatology耳鼻喉科ENTDept.(Otolaryngology)耳鼻喉科-一般门诊GeneralENTClinic耳鼻喉科-门诊小手术MinorSurgery耳鼻喉科-鼻窦内视镜门诊SinusEndoscopy科Urology科-一般门诊Urology-GeneralClinic科-性失禁IncontinenceClinic科-男性孕症MaleInfertilityClinic科-性功能障碍SexualDysfunctionClinic孕症学科Infertility妇产科ObstetricsandGynecology妇产科-孕症InfertilityClinic妇产科-子宫颈癌CervicalCarcinomaClinic妇产科-羊水穿Amniocentesis妇产科-妇科肿瘤GynecologicalOncology妇产科-子宫颈病变CervicalDysphasiaClinic妇产科-妇期MenopauseClinic妇产科-快速子宫颈抹片ExpressSmearService妇产科-抹片及乳房检查PapSmear妇癌科GynecologicOncology妇科学科GynecologyUrology眼科Ophthalmology眼科-青光眼GlaucomaClinic眼科-斜弱视StrabismusandAmblyopia眼科-视网膜RetinaSection眼科-一般门诊Optometry-GeneralClinic眼科-兵役检查MilitaryServiceEyeExam眼科-配光检查Optometry眼科-视保健VisionProtectionClinic床科部眼科-萤光摄影FluorescentPhotography眼科射OphthalmologicLaserTherapy精神科Psychiatry医院常用中英文对照汇编精神科-身心内科PsychosomaticClinic精神科-焦虑忧郁失眠门诊AnxietyandInsomniaClinic精神科-癌症团体心治GroupCancerTherapy精神科-儿童青少特别门诊(限18岁以下)YouthPsychiatry 放射线科Radiology核医科NuclearMedicine疼痛科PainManagement麻醉科Anesthesiology(Anesthesia)Dept.健科Rehabilitation解剖病科AnatomicalPathology预防注射科ProphylacticImmunization病科Pathology青少谘询特别门诊JuvenilePsychiatryDepartment肿瘤科Oncology神经内科Neurology神经外科Neurosurgery家庭医学科FamilyMedicine社区医学部CommunityMedicine心血管加护病房CardiacCU(CCU)心血管中心CardiovascularCenter心脏血管外科加护病房CardiovascularSurgeryICU急诊EmergencyDept.急诊医学科EmergencyMedicine内视镜科EndoscopySection血液透析Hemodialysis肝胆科Hepatology高危险妊娠症学科High-riskPregnancy安护HospiceCenter职业病科OccupationalMedicine放射肿瘤科RadiationOncology保健科PreventiveMedicine运动医学科SportMedicine肺结核加护病房TBICU外伤加护病房TraumaICU健康检查中心HealthEvaluationCenter脑血管中心CerebralVascularClinic神经医学中心BrainCenter烧伤中心BurnCenter癌症中心Cancercenter癌症防治中心CancerControlandPreventionCenter高压氧治中心HyperbaricOxygenTherapyCenter肥胖防治中心WeightReducing床科部洗肾中心HemodialysisCenter医学美容中心MedicalCosmeticCenter医学影像中心MedicalImageCenter运动健中心Rehabilitation-ExerciseCenter医院常用中英文对照汇编病人保健推广中心DiabeticCenter中西合作医中心Chinese-WesternCooperativeTreatmentCenter社区护HomeCare护之家NursingHome护部NursingDept./NursingDepartment护长室HeadNurse医技术CT登记处CTAdmissionX光摄影室(借片室)X-rayRoom孕症谘询室InfertilityConsultationRoom内分检查室EndocrineExaminationRoom内科诊查室InternalMedicineClinic内视镜室Endoscopy化学治Chemo-Therapy心电图室EKG心导管室CardiacCatheterizationRoom心脏血管中心CardiovascularCenter心脏血管检查室CardiovascularExaminations心脏超音波HeartEcho水室Hydrotherapeutics生化实验室BiochemicalLab生检查科PhysiologicalExam皮肤病诊断中心DermologicalPathologicalCenter 石膏室PlasterRoom光子刀治中心PhotonKnifeCenter多功能超音波室Multi-FunctionEchoRoom肌电图室EMG血库BloodBank血液肿瘤科Hematology血清免疫学实验室Immu-serologicalLab血管功能检查室VascularFunctionTest血管摄影室CardiacAngiography动检查室UrokineticExam.Room技术室TechnicalSupportDivision乳房超音波BreastEcho乳房摄影室Mammography儿童治室PediatricTherapyRoom儿童物治室PediatricPhysicalTherapy儿童职能治室PediatricOccupationalTherapy 呼吸治RespiratoryTherapy放射免疫分析室RadioimmunoassayUnit放射科登记室RadiologyRegistration医技术放射线治科Radiotherapy科微波热室GenitouroUrologic超音波UrologyEcho物治PhysicalTherapy物职能治室OccupationalandPhysicalTherapy 医院常用中英文对照汇编肺功能PFT肺功能室PulmonaryFunctionTesting门诊检验OupatientCheck-UPS门诊体检PhysicalCheck-Ups急诊X光室ERX-RayRoom胃镜室EndoscopyRoom胎儿影像中心3DLiveImageCenter气管镜室BronchoscopyRoom特殊检查室SpecialExamination胸部超音波ChestEcho闪烁摄影室DiagnosticImagingUnit骨质密检查室BoneDensity骨骼肌肉超音波室EchoforSkeletalMuscles 采室UrineCollectionRoom产房DeliveryRoom细胞遗传室Cytogenetics细菌研究室BacterialLaboratory麻醉科实验室AnesthesiologyLaboratory健科治室RehabilitationTherapy紫外线光室UltravioletTherapy肾功能室RenalFunction肾脏超音波RenalEcho视检查室Check-upforEyeSight周边血管室PeripheralVascularExamination 微生物实验室MicrobiologicalLab新生儿观察室ObservationRoom-NewBornBabies 眩检查室VertigoTest准分子射室LaserTreatment腹部超音波Abdominalecho腹膜透析室CAPD脑波室EEGUnit解剖病科实验室AnatomicalPathologyLaboratory 运动治室TherapeuticExerciseRoom射治室LaserTherapy电脑断层摄影室CTScanUnit电室ElectrotherapyRoom磁振造影扫描室MRIUnit膀胱功能室BladderFunctionTest膀胱镜室CystoscopyRoom语言治SpeechTherapy器官移植OrganizationTransplantation医技术检伤分Triage检验室Laboratory检验科LaboratoryMedicine检体收发室SpecimenCollection检体受紧急报告取EmergencyProcedure检体处室LabSamples医院常用中英文对照汇编营养室NutritionDept.床病室ClinicalPathology职能治OccupationalTherapy医务室(医站)Clinic药剂科(药局)Pharmacy摄影室DigitalImage听检查室HearingExam.Room体外震波碎石机Lithotripsy机械及电器场所总机PhoneOperator‘sRoom库房/储藏室/材库Storeroom/Storage卸货区LoadingArea变电室TransformerRoom/Substation/PowerRoom变电站PowerSub-station电气室ElectricalControlRoom/ElectricRoom配电室ElectricalDistributionFacilities中控室CentralControlRoom中央控制室ControlCenter能源设施部PowerSupplyDivision机械室MachineRoom工具间ToolRoom电脑机房ComputerFacilities资讯室机房DataProcessing发电机房Generators空调机房AirConditioningFacilities空调机械室AirConditioningFacilities/Air-conPlant 紧急出口/安全门EmergencyExit安全门Exit避难方向EvacuationRoute灭火器FireExtinguisher缓机/缓梯EscapeSling消防箱FireHose/Hydrant逃生梯EmergencyLadder通报设备AlertFacilities紧急照明EmergencyLight消防设备/消防栓Hydrant紧急电源EmergencyPower紧急避难梯EmergencyLadder/EmergencyStaircase防空避难处Air-raidShelter会议场所及教室会议室ConferenceRoom简报室BriefingRoom讨室MeetingRoom/SeminarRoom阅览室ReadingRoom研讨室MeetingRoom,SeminarRoom医师研究室Physicians‘Office医师讨室Physicians‘MeetingRoom医院常用中英文对照汇编研究室StudyRoom音控室AudioContralRoom演讲厅(大堂)Auditorium演讲室LectureRoom国际会议厅ConferenceHall第一会议室ConferenceRoomI第二会议室ConferenceRoomII会议室及图书室ConferenceRoomandLibrary盥洗场所化妆室/厕所Women‘sRestroom/Ladies‘Restroom 男化妆室/男厕所Men‘sRestroom/Gentlemen‘sRestroom 洗手间/盥洗室Restroom身心障碍专用厕所DisabledRestroom浴室Shower储藏及仓库中央供应室CentralSupplyCenter中央库房CentralStorage供应室SupplyRoom清洁工具室JanitorsRoom急诊清洁室ERJanitor洗衣房Laundry汅物间SoiledMaterials清洁班CleaningCrew告示或警告标示施工中UnderConstruction禁止吸烟NoSmoking禁止饮食NoFoodorDrink禁食槟榔Chewingbetelnutisprohibited禁止携带物NoPets严禁烟火NoOpenFlames请勿(禁止)进入NoEntry闲人勿进AuthorizedPersonnelOnly节约用水PleaseConserveWater请勿攀爬NoClimbing请用雨伞套PleaseUsePlasticUmbrellaCover随手关门KeepClosed随手关灯TurnOffLightsWhenLeaving高压危险,有电勿靠近KeepClear-HighVoltage电器设备,严禁擅入Donotenter!PowerEquipment告示或警告标示请取号码牌,静候叫号时迳往挂号处挂号Takeanumber.Gotocounterwhennumberiscalled.防火门火警时随手关门FireEscape-PleaseKeepClosed避难出口高逃生缓机EmergencyExit&EscapeSling紧急疏散方向图EvacuationPlan禁止将投手伸出扶梯外Pleasedonotstretchoutyourhandorhead您的位置Youarehere电梯内请勿交谈,请戴口罩Donottalkinelevator,Pleaseputonrespirator医院常用中英文对照汇编严禁工作人员戴手套触摸按钮Employee,pushingbuttomwithyourgroveonis prohibited资源回收及垃圾资源回收/垃圾分Recycling塑胶Plastic垃圾桶Trash垃圾处室DisposalArea特殊空间太平间Morgue其它药物医药分业谘询专线MedicalandPharmaceuticalConsultationInquiries 申诉案件及政革新专线Citizens‘Hotline身体健康检查谘询预约服务专线PhysicalExamination出入口及专用道请勿停NoParking请勿暂停NoStanding身心障碍专用坡道DisabledRamp入口Entrance出口Exit/WayOut(标示於地面)遵方向ThisWay汽出入口VehiclesExiting入口道ParkingEntrance位已满请勿进入NoVacancy限高MaxHeadroom停场停场(区)ParkingLot平面停场ParkingLot地下停场UndergroundParking体停场ParkingTower宾专用停位ReservedParking机停位MotorcycleParking身心障碍专用停位DisabledParkingOnly院内员工专用停场StaffOnly计程招呼站TaxiStand停场救护Ambulance电(扶)梯及梯电梯Elevator电扶梯Escalator紧急用电梯EmergencyElevator梯Stairs访客电梯VisitorElevator本电梯直达6-12Floor6and12Only本电梯限停1-5层1,2,3,4,5Only医院常用中英文对照汇编书表慢性病续处方笺ChronicIllnessPrescriptionSlip 慢性病续处方笺ChronicContinuousPrescription慢性病续处方笺RefillPresriptionsForChroniDisease 诊断书MedicalCertificate挂号费RegistrationFee证明费CertificationFee费AmbulanceFee特定医费SpecialMedicalFee部份负担费Self-PaymentFee诊察费DiagnosticFee病房费WardFee伙食费DietFee检查费LaboratoryFee放射线诊费X-RayFee治处置费TherapeuticTreatmentFee手术费OperationFee健治费RehabilitationTherapy血液血浆费BloodProductFee血液透析费HemodialysisFee麻醉费AnestheticFee特殊材费SpecialMedicalSupplyFee药费MedicineFee。

健康診断書CERTIFICATE OF HEALTHPlease fill out (PRINT/TYPE) in Japanese or English.氏名生年月日□男Male Name： , Date of Birth: ／／□女Female Family name First name , Middle nameApplicant健康診断の前に下記の質問に答えてください。

Please answer the questions below before submitting to a physician for your physical examination.1. 過去5年間に以下の病気あるいは大きな病気にかかったことがあれば記入してください。

Please check the list of diseases below and/or specify if you have had in the past five years.□ぜんそくAsthma □結核Tuberculosis □マラリアMalaria □てんかん Epilepsy □糖尿病 Diabetes □心臓病Heart Disease □腎臓病 Kidney Disease □肝臓病 Liver Disease □精神疾患 Psychosis□その他Other（）2.薬、食べ物、動物、その他でアレルギーがありますか。

はいいいえDo you have any allergies to drugs ,foods, animals and other? Yes ／No具体的に記入してください。

Please specify.( )3.現在、何かの病気で薬を常用していますか。

はいいいえAre you taking medication now? Yes ／ No 病名Disease 服用薬 medication( ) （）Physician1. 身体検査Physical Examination身長体重血液型 RH ＋Height cm Weight kg Blood Type － A B O AB血圧Blood Pressure mm/Hg ～mm/Hg視力Eyesight (R) (L) (R) (L) 色覚異常の有無□正常normal 裸眼without glasses 矯正 with glasses or contact lenses color blindness □異常 impaired聴力□正常 normalHearing □低下 impaired2. 申請者の胸部について、聴診とX線検査の結果を記入してください。

I authorize Illinois Institute of Technology to release this immunization record to the Illinois Department of Public Health (IDPH), or its designated representative for compliance audits or in the event of a health or safety emergency. All immunization documents submitted to IIT become the property of the University. I understand that, unless required to do so by law, IIT will not re-release my immunization records to any third party.我授权伊利诺理工大学来发布这份免疫记录给伊利诺斯州卫生部门，或者它指定的符合性审计的代表，或者一个健康的事件，或安全相关的紧急情况。

Please complete either Option A or Option B (choose one)请完成选项A或者B（二选一）。

❑ Option A: Attach a copy of your Official Immunization records proving ALL immunizations are current. Skip Option B.提供一份你的官方的免疫记录的副本，以证明现有的所有的免疫注射情况。

❑ Option B: See below – Remainder of form to be completed and signed by physician or health care provider.Option B: To be completed and signed by physician or health care provider. Please note the following: Exemptions: The following exemptions will be accepted with official supporting documentation.由（内科）医生或卫生保健提供者完成。

出国（境）人员健康体检必查项目
出国（境）人员健康体检必查项目
一、常规检查项目
（一）内科常规检查：身高、体重、腹围、血压、既往史。

（二）外科常规检查：脊柱、四肢、甲状腺、淋巴结，乳腺（女）。

（三）眼科检查：眼底。

（四）妇科检查（女）。

二、生化检验项目
（一）肝功能：谷草转氨酶、谷丙转氨酶、总蛋白、白蛋白、球蛋白、白/球、总胆红素、直接胆红素、间接胆红素、r-转肽酶、碱性磷酸酶、总胆汁酸。

（二）肾功能：尿素、肌酐、尿酸。

（三）空腹血糖。

（四）血脂：胆固醇、甘油三脂、载脂蛋白A1、载脂蛋白B、高密度脂蛋白、低密度脂蛋白。

（五）心肌酶谱：磷酸肌酸激酶同工酶、乳酸脱氢酶、磷酸肌酸激酶、a-羟丁酸脱氢酶。

（六）血常规、尿常规、便常规+潜血。

（七）类风湿因子、抗链“O”、C-反应蛋白、血沉。

（八）凝血四项。

HEALTH EXAMINATION REPORT FOR INTERNATIONAL STUDENTAND ACCOMPANYING PERSONPLEASE USE CAPITAL LETTERSSECTION 1 (To be completed by candidate)(PART A)FULL NAME (AS IN PASSPORT)INTERNATIONAL PASSPORT NO.NATIONALITY CONTACT NUMBERDATE OF BIRTH AGE SEX MARITAL STATUSMALE SINGLE D D M M Y Y FEMALE MARRIEDACADEMIC YEARSTUDENT IDPROGRAMME OF STUDY PROGRAMME CODENEXT OF KINNEXT OF KIN’S ADDRESSNEXT OF KIN’S CONTACT NUMBER ./SECTION 1(PART B) – Please tick ( √ ) in the relevant boxDeclaration of self and family illness. Explain in full if you or your family has any of the following illnesses. * Immediate family refers to father, mother, brothers / sistersSELF IMMEDIATE FAMILYMEDICAL PROBLEMSYes No Yes NoIf “Yes” please state.1. Congenital or inherited disorder2. Allergy3. Mental illness4. Fits, stroke, other neurological disease5. Diabetes Mellitus6. Hypertension7. Heart or vascular disease8. Asthma9. Thyroid disease10. Kidney disease11. Cancer12. Tuberculosis13. Drug addiction14. AIDS, HIV15. History of surgery16. Other illnessesCurrent medication (Long term)____________________________________ ____________________________________ ____________________________________ ____________________________________IMMUNIZATION HISTORY(where applicable)DATE IMMUNIZED1. Yellow Fever2. BCG3. Meningitis (Quadrivalent)4. Hepatitis B5. Others:I hereby certify that the information given above is true. I understand that my application will berejected if there is any false information given.Date Signature of candidateSECTION 2 - PHYSICAL EXAMINATIONTo be filled by examining doctor1. BASIC MEASUREMENTHEIGHT : __________________ m BLOOD PRESSURE : ______________ mmHg WEIGHT : __________________ kg PULSE RATE : ______________ / minVISION TEST : Unaided : (R) _______ (L) ________ Aided : (R) _______ (L) ________ COLOUR VISION TEST :NORMAL / ABNORMAL2. GENERAL EXAMINATIONITEM YES NO COMMENTa. DEFORMITIESb. PALLORc. CYANOSISd. JAUNDICEe. OEDEMAf. SKIN DISEASES3. SYSTEMIC EXAMINATIONITEM NORMAL ABNORMAL COMMENTa. EYES (including funduscopy)b. EARSc. NOSEd. ORAL CAVITY / THROATe. NECKf. HEARTg. LUNGSh. ABDOMEN / HERNIA ORIFICESi. NERVOUS SYSTEMj. MENTAL CONDITIONk. MUSCULOSKELETAL SYSTEMSECTION 3 - INVESTIGATIONSURINE TESTITEM DATE TAKEN RESULTa. ALBUMINb. SUGARc. MICROSCOPICd. MORPHINEe. CANNABISf. AMPHETAMINES TYPESTIMULANTBLOOD TESTITEM DATE TAKEN RESULTa. HEPATITIS Bs ANTIGENb. HEPATITIS Cc. HIVd. VDRL / TPHAe. MALARIAL PARASITECHEST X-RAY INFORMATIONCHEST X-RAY NO.DATE TAKENPLACE TAKENREPORTSECTION 4 - CERTIFICATION BY THE EXAMINING DOCTORPlease tick (√) in the appropriate boxI certify that I have on this date ___________________ examinedMr / Ms ___________________________________ Passport No. ____________________ and found him / her :-Date Signature of Doctor : Name of Doctor : Qualification : Hospital / ClinicRegistration Number :Official stamp:_________________________________________________________________________Remarks By University/College Official :IN GOOD HEALTHHAVING THE FOLLOWING MEDICAL COMPLICATION(S) (Please State)____________________________________________________ ____________________________________________________ ____________________________________________________UNDERGOING TREATMENT FOR: (Please State)____________________________________________________ ____________________________________________________ ____________________________________________________。

体检项目对照表
T1：物理体检、尿检（含镜检）、静止心电图
T2：T1+血液检查(HbsAg、ALT、AST、Glu、HDL、CHO、TG、r-GT)、
血常规
中文名称
英文缩写 备注 乙肝表面抗原 HbsAg 丙氨酸氨基转移酶 ALT 天门冬氨酸氨基转移酶 AST 葡萄糖(空腹血糖) GLu 高密度脂蛋白胆固醇 HDL 同HDL-C 总胆固醇 CHO 同TCHO 甘油三酯 TG 谷氨酰转肽酶 r-GT
T3：T2+血液检查（乙肝二对半、AKP、TBIL、DBIL、TP、A/G）、
肾功能（BUN、Cr）、腹部（妇科）B超（说明：腹部B超所含项目为：肝、胆、胰、脾、双肾、前列腺（>50周岁，男））
中文名称
英文缩写 备注 乙型肝炎病毒表面抗原 HBsAg 乙肝二对半
乙型肝炎病毒表面抗体 HBsAb 乙型肝炎病毒 e 抗原 HBeAg 乙型肝炎病毒 e 抗体 HBeAb 乙型肝炎病毒核心抗体 HBcAB 碱性磷酸酶 AKP ALP 总胆红素 TBIL 直接胆红素
DBIL
总蛋白 TP
白/球比值 A/G
尿素 BUN
肾功能 肌酐 Cr（CREA）
¾T4：T3+血液检查HCV-抗体、HIV、HBA1C（糖化血红蛋白）、胸片
中文名称 英文缩写 备注 丙肝抗体 HCV-抗体
艾滋病抗体 HIV
糖化血红蛋白 HBA1C
¾T5：T4+血液检查AFP、CEA、肺功能、运动平板心电图
中文名称 英文缩写 备注 甲胎蛋白 AFP
癌胚抗原 CEA。