MEDICAL CHECKUP

STUDENT INFORMATION

Name	null -
Faculty
IC No / Passport No
Status
Address	, , ,
Email

MEDICAL CHECKUP INFORMATION

Clinical Finding Lab Result International Student Consultation

GENERAL INFORMATION

CAMPUS

LOCATION

CXR

SMOKING?

PAST MEDICAL / SURGICAL HISTORY

OKU INFORMATION

OKU?

BODY WEIGHT MEASUREMENT

Weight

kg

Weight

cm

BMI

BLOOD PRESSURE

Not Treated Systolic

Treated Systolic

Diastolic

Pulse

VISION

(L)

(R)

COLOUR DEFICIENCY

%>

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