History and Physical Examination

We have a team of highly qualified ,experienced ,competent and registered medical doctor, health assistant and staff nurse for this purpose

Part I Personal Particulars of Foreign Worker

Name: ____________________________                        Passport No._______________

Sex: *Male / Female              Height: __________ cm         Occupation:__________________________________   Date of Birth: _______________

Citizenship: ____________        Weight: __________ kg

Part II Medical History

1 Mental illness                     6 Tuberculosis

2 Epilepsy                             7 Heart Disease

3 Chronic Asthma                 8 Malaria

4 Diabetes Mellitus               9 Operations

5 Hypertension

If yes,  brief details was taken

Part III General physical examination

pallor-     icterus-        cyanosis-     lymphadenopathy-    clubbing-       oedema-   dehydration-

vitals=

pulse-       bp-      temp-      rr-

Part IV Systemic examination

1 Cardiovascular System

  Heart Disease, murmur 

3 Respiratory System- crepitus, abnormal breathing sound

4 Abdomen

a Hernia               b Enlarged Liver          c Enlarged Spleen      d Genitourinary System

5 Skin-Chronic Disease (e.g. leprosy, widespread eczema, psoriasis, etc)

6 Locomotor/Neurological

a Significant limb amputation or deformity        b Limb movement and co-ordination

c Significant spinal deformity                             d Other significant abnormalities

7 Endocrine disorders, e.g. thyrotoxicosis

8 Mental state
9 Hearing – unable to hear ordinary conversation at 2m

10Vision (should be at least 6/12 in both eyes with

or without glasses.)

a Vision Acuity

i) Right eye            ii) Left eye

b Colour Vision

 Continue...........