PDO Medical examinations specification SP1230

Petroleum Development Oman LLCRevision: 3.0Effective: 16 Apr 20079.18 Appendix R: Initial Medical Examination Report (EX1) Q1Petroleum Development OmanMEDICAL DEPARTMENTINITIAL EXAMINATION REPORTSurnameForenamesAddressPlace of examinationDateHome telephone numberIf a dependant or fiancée enter employee‟s name here:Surname:Forenames:Birth date: Nationality: Country of birth: Religion:MaleFemaleSingleMarriedWidow (e)Divorced /SeparatedRelationship to employeeWife Son DaughterFianceeNumber ofchildren:Reason forexaminationPre-EmploymentPre-OverseasJob:Area:Name and address of family doctorAre you a Registered Disabled Person? (UK only)List your last 3 jobsPage 76 SP-1230 : Specification for Medical Examination, Treatment & Facilities Printed 25-Sep-08The controlled version of this CMF Document resides online in Livelink®. Printed copies are UNCONTROLLED.(1)(2)(3)Do you belong to any MedicalInsurance Scheme?DO YOU HAVE OR HAVE YOU HAD:- (Tick “Yes” or “No” column or put a (?) if uncertain exclude minorailments.)Y N Y N Y N1. Sinus trouble 22. Heart Disease 42. Awarded benefits2. Neck swelling/glands 23. Rheumatic feverfor industrialinjury/illness3. Difficulty in vision 24. Abnormal heartbeat 43. Treated for a mental4. Any ear discharge 25. High blood pressurecondition, egdepression5. Asthma/bronchitis 26. Stroke 44. Treated for problem6. Hayfever/otherdrinking or drug27. Serious chest painallergyabuse7. Any skin trouble 28. Any blood disease 45. Exposed to toxic8. Tuberculosis 29. Kidney diseasesubstance or noise9. Shortness of breath10. Coughed/vomitedblood11. Severe abdominalpain30. Painful passage ofurineFOR WOMEN ONLY31. Blood in urine Have you ever had:-32. Diabetes 46. An abnormal smear33. Headaches/migraine 47. Any gynaecological34. Dizziness/faintingtreatment12. Stomach ulcer 35. Epilepsy 48. Are you pregnant?13. Recurrent indigestion 36. Joints/spinal trouble 49. HAVE YOU HAD14. Jaundice or hepatitis 37. Surgical operationAN ILLNESS NOTMENTIONED15. Gall Bladder disease 38. SeriousABOVE16. Marked change inaccident/fracture