做血液检查的人员[Person taking blood]
请在表格上和照片的底部做标记（请不要涂抹照片），证实检查人确为申请人，包括验证日期。
官方使用[Office use only]
A部分——申请人的详细资料[ Part A-Applicant’s details]请申请人在参加体检之前完成该部分；请用钢笔，并用英语的大写字母清晰填写。[To be completed by the applicant before attending the medical examination. Please use a pen and write neatly in English using BLOCK LETTERS.]
1．全名[Your full name]、姓[Family name]、名[Given name]；
2. 住址[Your residential address]、邮编[postcode]；
3. 白天的联系电话[Daytime telephone number]、国家代码[country code]、地区代码（区号）[area code]、号码[number]；
4. 性别[Sex]、男[Male]、女[Female]；
5. 出生日期[ Date of birth]、日[DAY]、月[MONTH]、年[YEAR]；
6. 在澳大利亚计划的工作或活动（大概意思就是去干什么）[intended occupation/activity in Australia]；
7. 最近5年的工作是什么（就是说以前是干什么的）[previous occupations in the last 5 years]；
8. 最近的5年你在哪个国家居住[countries in which you have lived in the last 5 years]；
9. 如果你在澳大利亚居住：[if you live in Australia]：
☆你来了多久了[How long have been here?] 年[YEARS] 月[MONTHS]；
☆你现在持有的是哪种签证[ what visa subclass do you currently hold]；
10. 你准备在澳大利亚逗留多长时间[ How long do you intend staying in Australia]：
☆永久[Permanently]（包括非移民申请）[including non migrating applicant]；
☆暂时[Temporarily]：多长时间？[For how long?] 年[YEARS]、月[MONTHS]；
11. 你申请哪种签证？[For which visa class are you applying?]；
12. 你是否已经向移民局的相关办事处提出过申请？ [Have you lodged an application at an office of the Department of immigration and Multicultural and Indigenous Affairs?]
☆没有[no] 你将向哪个办事处提出申请？ [At which office do you intend to lodge an application?]；
☆是的[yes] 哪个办事处？[which office?]；
13. 你是否是[Are you]：
☆被澳大利亚居民收养的儿童？[a child for adoption by an Australian resident?]
☆无监护人的难民儿童？[an unaccompanied minor refugee child?]
☆曾经居住过或者正在居住露营的难民？[a refugee who has lived or is living in a camp?]
14. 在澳大利亚，你将会：［in Australia, will you be: ］
☆参加或者教授课程［attending or teaching classes?］
☆加入健康保护组织［involved in health care］
☆加入儿童保护或者孤儿救助［involved in childcare/creche?］
15. 你是否曾经：［Have you EVER had］
☆动过手术[an operation]；
☆因为某些原因而住院治疗[hospital treatment or been admitted to a hospital for any reason]；
☆肺结核或者是不正常的胸透，咳血，或接触过肺结核病人[tuberculosis or an abnormal chest x-ray, or have you ever coughed up blood or had contact with a person with tuberculosis]；
☆惊阙或癫痫[convulsions, fits or epilepsy]；
☆焦虑，压抑，紧张为主述需要治疗[anxiety, depression or nervous complaints requiring treatment]；
☆因为精神上的疾病需要入院治疗，或者见精神病医生[admission to a hospital for a psychological problem or consulted a psychiatrist]；
☆高血压，心脏病，喘不上气或者胸痛．[high blood pressure, heart trouble, breathlessness and/or chest pain?]；
☆背部，颈部或关节疼痛[pain in back, neck or any joint]；
☆胃疼，消化不良或者烧心[stomach pains, indigestion or heart burn]；
☆得传染性疾病持续两个星期以上[an infectious disease lasting more than 2 weeks]；
☆肾脏或膀胱问题[kidney or bladder disease or complaint]；
☆糖尿病或尿里含糖[diabetes or sugar in the urine]；
☆任何疾病超过两个星期，或者以上未提及的周期性疾病[any illness, injury or medical condition lasting more than 2 weeks，or a recurring condition not mentioned above]；
☆最近５年内，任何内科的，外科的或精神上疾病的治疗[any medical, physical, psychological or other treatment in the last 5 years]；
