Has the applicant been previously examined for immigration into Canada ?(Yes or No, if Yes, pls show Date, City and Country) 申请人是否曾经为移民加拿大而接受体格检查？ (是或否，如果是，请提供时间地点)
Has the applicant used addictive or mood alerting drugs?(Yes or No) 申请人是否服用上瘾药物或兴奋剂？(是或否)
Does the applicant consume alcohol? (Yes or No, if Yes, How much?) 申请人是否酗酒？(是或否，如果是，数量？)
Does the applicant smoke or has the applicant ever smoked tobacco? (Yes or No, if Yes, How much?) 申请人是否吸烟或曾经吸烟？(是或否，如果是，数量？) Has the applicant ever suffered from or been told he had any of the fo llowing conditions?(Yes or No)
Head or neck injury 头部或颈部受伤 Nose or throat trouble 鼻或喉疾病 Ear trouble or deafness 耳部疾病或耳聋 Eye trouble 眼疾 Chronic cough or asthma 慢性咳嗽或气喘 Tuberculosis 肺痨 Other lung disease 其他肺部疾病 High blood presure 高血压 Heart trouble 心脏病 Rheumatic fever 风湿性热 Diabetes mellitus 糖尿病 Endocrine disorders 内分泌疾病 Cancer or tumor 癌或肺瘤 Rheumatism, joint or back troubles 风湿性关节或脊背疾病 Mental disorders 精神病 Faiting spells, fitsor seizures 突发性眩晕，痉挛或癫痫 Chronic skin condition 皮肤病 Stomach pain or ulcer 胃病或溃疡 Other abdominal touble 其他肠胃疾病 Kidney or bladder trouble 肾病或膀胱疾病 Sexually transmitted disease 性病 HIV positive 爱滋病阳性反应 Genetic or Familial disorders 遗传性疾病 Typhoid fever, malaria, tropical disease 伤寒，疟疾或热带病 Operations 曾经动过手术 Have you ever had a blood transfusion 曾经接受输血
Is the applicant now taking any medication or receiving treatment whic h must be continued in the future?(Yes or No) 申请人是否正在服药或要继续治疗？(是或否)
Please elaborate on all "yes" answers of questions include significant dates and know treatment. 对以上回答“是”的问题请详细说明，包括治疗日期。
Physical examination to be completed by the examining physician. 体格检查，由检验医生完成本报告。 Upon medical examination are there any abnormalities of the following:
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