Has the applicant been previously examined for immigration into Canada
?(Yes or No, if Yes, pls show Date, City and Country)
申请人是否曾经为移民加拿大而接受体格检查？
(是或否，如果是，请提供时间地点)

Has the applicant used addictive or mood alerting drugs?(Yes or No)
申请人是否服用上瘾药物或兴奋剂？(是或否)

Does the applicant consume alcohol? (Yes or No, if Yes, How much?)
申请人是否酗酒？(是或否，如果是，数量？)

Does the applicant smoke or has the applicant ever smoked tobacco?
(Yes or No, if Yes, How much?)
申请人是否吸烟或曾经吸烟？(是或否，如果是，数量？)

Has the applicant ever suffered from or been told he had any of the fo
llowing conditions?(Yes or No)

Head or neck injury 头部或颈部受伤
Nose or throat trouble 鼻或喉疾病
Ear trouble or deafness 耳部疾病或耳聋
Eye trouble 眼疾
Chronic cough or asthma 慢性咳嗽或气喘
Tuberculosis 肺痨
Other lung disease 其他肺部疾病
High blood presure 高血压
Heart trouble 心脏病
Rheumatic fever 风湿性热
Diabetes mellitus 糖尿病
Endocrine disorders 内分泌疾病
Cancer or tumor 癌或肺瘤
Rheumatism, joint or back troubles 风湿性关节或脊背疾病
Mental disorders 精神病
Faiting spells, fitsor seizures 突发性眩晕，痉挛或癫痫
Chronic skin condition 皮肤病
Stomach pain or ulcer 胃病或溃疡
Other abdominal touble 其他肠胃疾病
Kidney or bladder trouble 肾病或膀胱疾病
Sexually transmitted disease 性病
HIV positive 爱滋病阳性反应
Genetic or Familial disorders 遗传性疾病
Typhoid fever, malaria, tropical disease 伤寒，疟疾或热带病
Operations 曾经动过手术
Have you ever had a blood transfusion 曾经接受输血

Is the applicant now taking any medication or receiving treatment whic
h must be continued in the future?(Yes or No)
申请人是否正在服药或要继续治疗？(是或否)

Please elaborate on all "yes" answers of questions include significant
dates and know treatment.
对以上回答“是”的问题请详细说明，包括治疗日期。

Physical examination to be completed by the examining physician.
体格检查，由检验医生完成本报告。

Upon medical examination are there any abnormalities of the following:

体检中是否发现以下不正常的情况：

Head and Neck 头和颈部
Mouth and throat 口腔和喉部
Ears 耳
nose 鼻
Eyes including fundi 眼睛包括眼底
Heart 心脏
Chest, lungs and breast 胸，肺和乳房
Abdomen, liver, spleen,etc. 腹部，肚，脾等
Genito-urinary system 泌尿生殖系统
Hernial sites 疝气
Extremities and spine 脊柱和四肢
Nervous system 神经系统
Skin including surgical scars 皮肤包括手术疤痕
Lymphatic system 淋巴系统
Evidence of mental abnormality 精神病症状
Any other abnormalities 其他不正常情况
Female applicant pregnant if yes, date of L.M.P. 女申请者是否怀孕？如是
，注明最后月经日期
Is the appllicant now taking medication or receiveing treatment of any
kind? If so, specify
申请人目前是否服用药物或接受其他治疗？如是，请说明
Height 身高

Weight 体重

Visual acuity with glasses if worn 视力(如近视则测矫正视力)

Hearing whispered voice(normal: 6 meters(20 feet)) 听力

Blood presure 血压

If abnormal repeat B.P. after resting 如果不正常，稍后再量

Pulse rate 脉搏

Pulse rhythm 脉搏节率

Mental development 智力发育(正常与否)

Please elaborate on all "yes" answers or abnormalities
请对回答是“是”的问题加以详细说明

Routine blood serologial tests for syphils (Candidates 15 years of age
and older)
梅毒常规血清试验(15岁以下申请人免检)

FTA-ABS.(only in VDRL positive)

Urinalysis (Candidates 5 years of ages and older)
尿检(5岁以下免检)

Protein 蛋白
Sugar 糖
Microscopic 显微镜检验结果 If abnormal, repeat.
Large postero anterior chest X-ray film and report (required for all a
pplicants 11 years of ages and older)
所有11岁以上人士必须进行X光检查。

Skeleton/soft-tissue
Cardiac shadow
Hilar & mediastinal nodes
Hemidiaphragms and CPAs
Parenchymal infiltrates
Pulmonary nodules
Pleural fibrosis/effusion
Interstitial fibrosis
Cavitation
Other abnormalities
以上资料来自加拿大体检报告书，其中并没有提到对肝功能的各种检查。