ࡱ> ikh'` Rl9bjbj{P{P8^::!!!!$:!2j2"2"2"2"2"2"2"2"k1m1m1m1m1m1m1$3h5F1E2"2"2"2"2"12"2"1B+B+B+2"2"2"k1B+2"k1B+B+-.2"&" ;;h!)-7.4102-,46V*46.46.(2"2"B+2"2"2"2"2"118+ 2"2"2"22"2"2"2"D!! Y V N SO v|^yqN|^yuToxicomania ----------------------------------------------------------Mental Confusion --------------------------------------------------------Psychosis rW Manic psychosis ------------------------------------------ Y`W Paranoid psychosis --------------------------------------- {^ɉW Hallucinatory psychosis ---------------------------------%No%   $x|~    0 b h l n P R X Z ` b h j p r z | huCJhuCJo(hu huo(huCJOJQJo(huCJPJhuCJPJo(Q$xz   $d8$Ifa$$d8$1$Ifa$$If $$Ifa$ $$1$Ifa$ $$1$Ifa$ $$Ifa$d$da$l9    & $$Ifa$kd$$IfTl4?֞B DNs%   4    y ,  0&64 laf4T     $$Ifa$ $$1$Ifa$ " 0 & $$1$Ifa$kd{$$IfTl4+֞B DNs% 4 y , 0&64 laf4T0 ` b h t ~ Ckd$$IfTl4\ s% , 0&64 laf4T$If $$1$Ifa$ $$Ifa$ $$Ifa$ l 7... $$Ifa$kd$$IfTl4ֈB s% p , 0&64 laf4T   4 P X ` h p z ||$If $$1$Ifa$ $$Ifa$ikd$$IfTl46%&  0&64 laf4Tz  > F N V ^ h r | $If $$Ifa$ $$Ifa$ $$1$Ifa$ > @ F H N P V X ^ ` h j r t | ~ *<"$68:PRfn\^nzt222 22222 2(2*22242<2>2F2H2P2T2X2p2r2~222Uhu huo(` kd$$IfTl4ִ DN(sT"%W -4 CI 0&6    4 laf4T *_kd\$$IfTl4cF%@  0&6    4 laf4T $$1$Ifa$$If $.68:\t~~~~~~~ $$Ifa$ikd$$IfTl4%&  0&64 laf4T$If $$Ifa$2222(222<2F2P2$If $$1$Ifa$ No%No%No%No%Yes%Yes%Yes%Yes%Yes ؚ Ss|Height cmSO ͑ CSKQWeight Kg@ S CS^Blood pressure KpaS ` QDevelopment% {Q ` QNourishment NeckƉ R ]L Vision SRw ck Ɖ R ]L Corrected vision SRe'`~8h~nu|^yuVenereal DiseaseOpening lung tuberculosisAIDSPsychosisa Suggestion;S ^ ~{ W[Signature of physicianhgUSMOvzOfficial Stamp e g DateP2R2~2223T33]WWWWWW$Ifkd6 $$IfTl4 \2sT"% =I 0&64 laf4T222223 3(323:3>3@3R3333333333333333333333344444"4&4(4*4,4.40424:4<4B4d4h4l4n4z4~444444444444444444444444555$5&5456585:5L5R5T5X5d5 hu>*o( hu>* huo(hu]33333333smmmmmm$Ifkdd $$IfTlF Q% CF 0&6    4 laT334&4D4l4p4z4pjjjjjj$Ifkd> $$IfTl4F Q% CF 0&6    4 laf4Tz4|4444444pjjjjjj$Ifkd $$IfTl4F Q% CF 0&6    4 laf4T44444455pjjjjjj$Ifkd $$IfTl4F Q% CF 0&6    4 laf4T555$5(545<5L5pjjjjjj$Ifkd$$IfTl4F Q% CF 0&6    4 laf4TL5N5P5X5d5n5555pkeeeeee$If$a$kd$$IfTl4F Q%  C F  0&6    4 laf4Td5f5j5n555555555555555555 626:6D6p667777777777788888889&9P9T9V9X9Z9\9h9j9l9hu huo(65555rll$Ifkd$$IfTl4F %  W   0&6    4 laf4T55 6$60626:6B6D6 $$Ifa$fkd$$IfTl4%&  0&64 laf4TD6F6R6`6p666666_VVVVVVVV $$Ifa$kdR$$IfTl4; \}% j   0&64 laf4T 6677|v$If $$Ifa$ykdQ$$IfTl40%  0&64 laf4T77777777777788xxx $$1$Ifa$$9$If^9a$$Ifikd$$$IfTl4%&  0&64 laf4T88(80888Z8888$If $$1$Ifa$ $$Ifa$ $$1$Ifa$88888888JDDDDDD$Ifkd$$IfTl4r%Y  T 0&64 laf4T888899&9D9F9H9J9L9N9P9Z9f9h9 $$1$Ifa$$Ifh9j9l9~$a$|kd*$$IfTl40%s    0&64 laf4T6182P:p'L. A!"#$n%S y$$If!vh55535 55 5)#v#v#v3#v #v#v #v):V l4?0&6++++++,55545 55y 5,/  / / /  /  4af4Tk$$If!vh55535 55 5)#v#v#v3#v #v#v #v):V l4+0&6++++++,55545 55y 5,/  / / /  4af4T$$If!vh5 555)#v #v#v#v):V l40&6++,5 555,/  /  4af4T*$$If!vh555n5 55)#v#v#vn#v #v#v):V l40&6++,555p5 55,/  /  4af4T$$If!vh5&#v&:V l460&6,5&/  / 4af4T$$If!vh5V5,535 55K55H#vV#v,#v3#v #v#vK#v#vH:V l40&6,5W5-545 55C55I/  / / / / / /  4af4T$$$If!vh5:55#v:#v#v:V l4c0&6,5@55/  /  / / / / /  4af4T$$If!vh5&#v&:V l40&6,5&/  / 4af4T,$$If!vh55A55H#v#vA#v#vH:V l4 0&6,55=55I/  /  / / / /  4af4T$$If!vh5 5@5K#v #v@#vK:V l0&6,5 5C5F/  /  4aT$$If!vh5 5@5K#v #v@#vK:V l40&6,5 5C5F/  /  4af4T$$If!vh5 5@5K#v #v@#vK:V l40&6,5 5C5F/  /  4af4T$$If!vh5 5@5K#v #v@#vK:V l40&6,5 5C5F/  /  4af4T$$If!vh5 5@5K#v #v@#vK:V l40&6,5 5C5F/  /  4af4T$$If!vh5 5@5K#v #v@#vK:V l40&6,5 5C5F/  /  /  4af4T$$If!vh5 5W5 #v #vW#v :V l40&6,5 5W5 /  /  /  / 4af4T$$If!vh5&#v&:V l40&6,5&/ /  4af4T$$If!vh55j 55 #v#vj #v#v :V l4; 0&6,55j 55 /  / /  4af4T$$If!vh55#v#v:V l40&6,55/  / /  4af4T$$If!vh5&#v&:V l40&6,5&/  / 4af4TP$$If!vh5Y55 5T5#vY#v#v #vT#v:V l40&6,5Y55 5T5/  /  / / / / /  4af4T$$If!vh5s5 #vs#v :V l40&6,5s5 /  / / /  4af4TN@N cke $1$a$$CJKHPJ_HaJmH nHsH tH@@@ h 1$$@&a$CJOJPJQJ$A$ ؞k=W[SOFi@F nfhCDoT.x #()?Xr "68=>DQUZ`lmotv{!"#)08CIXghi -GLVW[fghijklt00000 00 00 00 00 00 000 0 0 0 0 0 0 0 0 0 00 0 000 0 0 00 0 00 0 0 0 0 000 0 0000 0000 0000 0000 0000 0000 0000 0000 0 000 000 000 0 000 0 00000 00000 00000 00000 0 00 00 00 0 00 00 00 0 00 00 00 0 00 00 00 0 00 00 00 0 00 00 00 0 000 00 00 0 00 0 000 0 00 0 0 0000000 0 0 00 0 0000 0000 0000 0000 0000 0 00000000000 00000000000 0 0 2d5l9 %  0 z P233z445L555D667888h9l9  !"#$&'()*+,-.l9  =>?@HJOQRTabcdefgh~bfglmops #$'(+,/0459:>?DLou789<{~  #$)*,-<>XY[\oq3467>?@ABCDJQRSTZ[\]^_mntu{|}~#()/07i  WXYZlmnopqrsruUXtuCGlms3ssssss33s=AHi~bg#rW!r ˦hh^h`OJPJQJ^Jo(% H\H^H`\OJQJo(n \^`\OJQJo(u \^`\OJQJo(l 4\4^4`\OJQJo(n  \ ^ `\OJQJo(u | \| ^| `\OJQJo(l  \ ^ `\OJQJo(n \^`\OJQJo(u!rB        u'Lx[P#=FHOUa~abt/CD()X6=>QZlmt{!"#ghi VW@X<{@pp ppp2UnknownGz Times New Roman5Symbol3& z Arial;ўSOSimHei;[SOSimSun;Wingdings qhZdfFjYLjLj!-!),.:;?]}    & 6"0000 0 000000 =@\]^([{  0 0 00000;[2d@HX(?#2Name ShnuOffice Oh+'0l   ( 4@LT\dNameNormal ShnuOffice106Microsoft Office Word@V)20@.@hI%@/hLj՜.+,0 X`px QW Co.'   !"#$%&'()*+,-./123456789:;=>?@ABCDEFGHIJKLMNOPQRSTUVWYZ[\]^_abcdefgjRoot Entry FpNL;hlData 01Table<D6WordDocument8^SummaryInformation(XDocumentSummaryInformation8`CompObjm  FMicrosoft Office Word ĵ MSWordDocWord.Document.89q