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Medical Checkup Form

This document outlines the medical checkup requirements for obtaining a work visa in Bahrain for individuals from countries without a GCC accredited medical center. It includes sections for personal data, vital signs, clinical examinations, laboratory investigations, and mental status assessments. The form concludes with a declaration for the medical professional to affirm the accuracy of the information provided.

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hasanhayat798
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525 views2 pages

Medical Checkup Form

This document outlines the medical checkup requirements for obtaining a work visa in Bahrain for individuals from countries without a GCC accredited medical center. It includes sections for personal data, vital signs, clinical examinations, laboratory investigations, and mental status assessments. The form concludes with a declaration for the medical professional to affirm the accuracy of the information provided.

Uploaded by

hasanhayat798
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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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 / Height CM ECG normal abnormal

color vision normal abnormal


pulse regular irregular Weight KG
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:

Laboratory Investigation

Routine Serology URNE


Normal Abnormal Result Result
Others HBsAg Negative Positive Sugar
Others HCV Negative Positive Albumin
Amoebae HIV Negative Positive Blood
Flagyl VDRL Negative Positive
RBC
WBC
Mental Status Examination
Findings Findings
A- Appearance C- Mood
Speech D- Thoughts
Behavior Others
B- Cognition Vaccination
Orientation Polio Yes No
Memory MMR Yes No
Concentration Others
RESULT Fit Unfit

Hospital Stamp

DECLERATION

I hereby have no objection to release any information content in this request to the concerned
authority.

I Dr declare that all information given is true.

Signature Date

*Please refer to the general guidelines for the pre-employment examination for expatriates at www.lmra.bh.
*Polio vaccination mandatory in reported country /MMR is must for expatriates from endemic area.

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