royal embassy of saudi arabia in rome

ROYAL EMBASSY OF SAUDI ARABIA IN ROME
MEDICAL REPORT
Name:
photo (1)
Sex:
Age:
Passport No:
Status:
Nationality:
Place & date of issue:
Position applied for:
Dear Sir,
Please arrange to examine the above mentioned candidate whether he
is fit for above mentioned position
Date:
Recruitment Attached
History of any significant past illness including:
1. Psychiatric and neurological disorders (Epilepsy, depression....);
2. Allergy;
3.
MEDICAL EXAMINATION
Type of medical exam
Result
Eye
vision
R. Eye
L. Eye
other
R. Eye
L. Eye
Ear
LABORATORY INVESTIGATIONS
Type of lab. Investig.
Result
URINE
- Sugar
- Albumin
- Bilharziasis
- Other
R. Eye
L. Eye
CHEST X RAY (2)
STOOL
-
SYSTEMIC EXAMINATION
- Blood Pressure
- Heart
- Lungs
- Abdomen
OTHER
Helminthes
Bilharziasis
Salmonella/Shigella
V. Cholera
Others
BLOOD
- Haemoglobin
- Malaria Film
- Other
* Hernia
* Varicose veins
- Extremities
- Skin
SEROLOGY
- Hiv test
- F.B.S.
- HBsAg/Anti HCV
- L.F.T.
- Creatinine
- Urea
VENERAL DISEASES
- Clinical
- Lab
VDRL
............
PREGNANCY TEST
1 of 2
N/A
N/A
N/A
- Notes about medical and laboratory investigations
Dear Sir,
Mentioned above is the medical report for Mr.
He is fit (4)
for above mentioned job.
Chief Physician
Stamp
Name:
Signature:
(1) Stamp of recruitment attached on the photo and application;
(2) Chest:
Free 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 ti the health authorities in Saudi Arabia.
2 of 2