Royal Embassy of Saudi Arabian
MEDICAL REPORT
NAME :……………………………….
SEX :………….. AGE :……….. STATUS :…………….NATIONALITY :……………………….
PASSPORT N° :………………….. PLACES & DATE OF ISSUE :……………………………..
PHOTO
POSITION APPLIED FOR :……………………………………
DEAR SIR / MADAM PLEASE, ARRANGE TO EXAMINE THE ABOVE MENTIONED
CANDIDATE AS TO HIS/HER FITNESS FOR THE ABOVE MENTIONED POSITION
DATE ____/ ____ / _____ RECRUITMENT ATTACHE
HISTORY OF ANY SIGNIFICANT PAST ILLNESS INCLUDING:
1. PSYCHIATRIC AND NEUROLOGICAL DISORDERS (EPILEPSY, DEPRESSION…)
2. ALLERGY
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MEDICAL EXAMINATION LABORATORY INVESTIGATIONS
TYPE OF MEDICAL EXAM : RESULTS TYPE OF LAB, INVES : RESULTS
R.EYE (URINE)
VISION
L.EYE - SUGAR
EYE
R.EYE - ALBUMIN
OTHERS
L.EYE - BILHARZIASIS
CHEST X RAY - OTHERS
(SYSTEMIC EXAMINATION) (STOOL)
- BLOOD PRESSURE - HELMINTHES
- HEART - BILHARZIASIS
- LUNGS - SALMONELLA/SHIGELLA
- ABDOMEN - V. CHOLERA
HERNIA - OTHERS
- OTHERS VARICOSE
(BLOOD)
VEINS
EXTREMITIES - HIV TEST
SKIN - F .B. S
(VENEREAL DISEASES) - HBsAg /Anti HCV
- CLINICAL - L. F. T
VDRL - CREATININE
- LAB - UREA
TPHA
PREGNANCY TEST
Royal Embassy of Saudi Arabian
MEDICAL REPORT
- Notes about medical and laboratory investigations
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Dear Sir Mentioned above is medical report for Mr./Mrs./Miss
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He/ She is : Fit [ ]
For the above-mentioned job
Unfit [ ]
Stamp
Chief physician
Name:………………………………………..
Signature:…………………………………
(1) Stamp of the recruitment attached on the photo and application
(2) Chest: Fee of pathological changes
(3) HIV for countries required
(4) To be fit all medical examination and laboratory investigations should be within normal limits
The medical report and x-ray should be submitted to health authorities in Saudi Arabia