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 following 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 which 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 applicants 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，注意其中并没有提到对肝功能的各种检查。