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["附件2："]
["宁夏回族自治区申请教师资格人员体检表"]
["姓名",null,null,"年龄",null,"性别",null,null,"婚否",null,null,"民族",null,"相片"]
["籍贯",null,null,"申请资格种类",{"$nulls":4},"联系电话"]
["既 往 病 史（如有病史，请在项目前□内打√）"]
["    请本人如实填写既往病史，如有隐瞒，由本人承担相应责任。",{"$nulls":3},"□严重肠胃疾病  □恶性肿瘤  □癫  痫  □精神病  □癔  症"]
[{"$nulls":4},"□晚期血吸虫病  □红斑狼疮  □心脏病  □肺结核  □糖尿病 "]
[{"$nulls":4},"□类风湿性关节炎  □淋病、梅毒、艾滋病等"]
["本人签字：",{"$nulls":3},"□其他病史："]
["以上栏目由申请人填写"]
["五   官  科","裸眼视力",null,"右",{"$nulls":4},"矫正视力",null,"右",null,null,"医师意见："]
[{"$nulls":3},"左",{"$nulls":6},"左"]
[null,"辨色力",{"$nulls":4},"眼病",{"$nulls":6},"签名："]
[null,"听力",null,"左耳             米",{"$nulls":5},"右耳              米",{"$nulls":3},"医师意见："]
[null,"耳疾"]
[null,"鼻",null,"嗅 觉",null,null,"鼻及鼻窦"]
[null,"面部",{"$nulls":4},"咽喉"]
[null,"口腔唇腭",{"$nulls":4},"齿"]
[null,"其他",{"$nulls":11},"签名："]
["内    科","血压",{"$nulls":5},"心脏及血管",{"$nulls":5},"医师意见："]
[null,"呼吸系统",{"$nulls":5},"腹部器官"]
[null,"其他",{"$nulls":11},"签名："]
["外   科","淋巴",{"$nulls":5},"脊柱",{"$nulls":5},"医师意见："]
[null,"四肢",{"$nulls":5},"关节"]
[null,"皮肤",{"$nulls":5},"颈部"]
[null,"其他",{"$nulls":11},"签名："]

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["B超检查",{"$nulls":4},"医师意见：            "]
[{"$nulls":5},"签名："]
["放射科",{"$nulls":4},"医师意见：            "]
[{"$nulls":5},"签名："]
["心电图",{"$nulls":4},"医师意见：            "]
[{"$nulls":5},"签名："]
["肝功",{"$nulls":4},"医师意见：            "]
[{"$nulls":5},"签名："]
["申请幼儿园教师资格体检项目增加","滴虫","念球菌","淋球菌","梅毒螺旋体","医师意见：            "]
[{"$nulls":5},"签名："]
["体检结论"]
[]
[]
[]
[null,"负责医生签名："]
["体检医院   意见"]
[]
[]
[]
[null,"体检负责人签名：",null,null,"体检医院公章"]
[{"$nulls":4},"年   月   日"]

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