This form is applicable in countries with no GCC accredited medical center
Medical checkup requirement for permission work visa in kingdom of Bahrain
SECTION 1: Personal Data
Name Age
Nationality Passport No.
Photo DOB SEX
Marital status married single divorced widow
CPR/IF applicable JOB Title
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
Cardiovascular Examination Respiratory Examination
General appearance N AB Ascultation N AB
Auscultation N AB Chest x-ray N AB
note:
Labratory Investigation Serology RESULT Fit UNFIT
Result
Hospital Stamp
Stool HBsAg Negative Positive
Normal Ubnormal HCV Negative Positive
OVA HIV Negative Positive
CYST VDRL Negative Positive
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 www.lmra.bh
*Polio vaccination mandatory in reported country /MMR is must for expatriates from endemic area.