application - sri lankan government scholarships for foreign students
application - sri lankan government scholarships for foreign students
application - sri lankan government scholarships for foreign students
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HEALTH CERTIFICATE<br />
FOREIGNER PHYSICAL EXAMINATION FORM<br />
(Please put a … in relevant cage )<br />
Name : Sex:<br />
Male<br />
Present mailing address:<br />
Nationality :<br />
Have you ever had any of the following diseases?<br />
Female<br />
Birth place:<br />
11<br />
Date of Birth :<br />
Blood group:<br />
PHOTO<br />
Yes No Yes No<br />
Typhus fever Bacillary dysentery<br />
Poliomyelitis Brucellosis<br />
Diphtheria Viral hepatitis<br />
Scarlet fever Typhoid and paratyphoid fever<br />
Relapsing fever Epidemic cerebrospinal meningitis<br />
Do you have any of the following diseases or disorders endangering the public order and security?<br />
Toxico mania<br />
Mental confusion<br />
Psychosis: Manic psychosis<br />
Paranoid psychosis<br />
Hallucinatory<br />
Height : cm<br />
Development:<br />
Vision:<br />
Colour sense:<br />
Ears:<br />
Heart:<br />
Yes No<br />
Weight: kg<br />
Nourishment:<br />
Corrected vision:<br />
Skin:<br />
Nose:<br />
Lungs:<br />
Blood pressure: mmHg<br />
Neck:<br />
Eyes:<br />
Lymph nodes:<br />
Tonsils:<br />
Abdomen:
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