Kingdom of Bahrain
Ministry of Health
Primary care & public health
This form is applicable in countries with no GCC accredited medical center
Medical checkup requirement for permission work visa in kingdom of Bahrain
SECTION1: Personal Data
Name
Age
Nationality
Passport No.
Photo
DOB
SEX
married
single
divorced
widow
Marital status
JOB Title
CPR/IF applicable
SECTION 2 : Vital Data
blood pressure
/
Hight
Kg
ECG
normal
abnormal
coloure vision
normal
abnormal
pulse
regular
irregular
Weight
Cm
vision
RT
/6
LT
/6
SECTION3: Clinical Examination/Lab Investigation
Clinical Examination
Respiratory Examination
Cardiovascular Examination
General appearance
N
AB
Ascultation
N
AB
N
AB
N
AB
Auscultation
Chest x-ray
note:
RESULT
Fit
UNFIT
Labratory Investigation
Serology
Result
Hospital Stamp
HBsAg
Stool
Negative
Positive
Negative
Normal
Ubnormal
HCV
Positive
Negative
Positive
OVA
HIV
Negative
Positive
CYST
VDRL
Amoebae
URNE
Flagyal
Sugar
RBC
Albumin
WBC
Blood
DECLERATION
I hereby
have no objection to release any information content in this requst to the concerned
authority.
I Dr
declare that all information given is true.
Signature
Date
*kindly refer to the pre-employment examination general rules for expatriates
*Polio vaccination mandatory in reported country /MMR is must for expatriates from endemic area.