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["吉林省申请中小学教师资格人员体格检查表"]
["姓名",{"$nulls":3},"性别",null,"毕业学校",null,null,"专业"]
["身份证号",{"$nulls":5},"申报学科"]
["既往病史（此栏由\n申请人如实填写）",null,"有无精神病史：  1无□  0有□",{"$nulls":3},"肝炎：  1无□  0有□"]
[null,null,"性传播性疾病：  1无□  0有□",{"$nulls":3},"结核：  1无□  0有□"]
[null,null,"皮肤病： 1无□  0有□",{"$nulls":3},"其它： 1无□  0有□",null,"本人签字："]
["眼\n科","裸眼\n视力",null,"右",null,"矫正\n视力","右 矫正度数",null,"检查者","医师意见：□\n1合格，2不合格（以下医师意见的填涂类同）\n签名："]
[{"$nulls":3},"左",null,null,"左 矫正度数"]
[null,"眼病",{"$nulls":4},"是否\n口吃","1无□\n0有□"]
["内\n科","血压",{"$nulls":6},"检查者","医师意见：□\n\n签名："]
[null,"心脏及\n血管",null,"1正常□\n2其它□",null,"精神机能",null,"1正常□\n2其它□"]
["外\n科","身高",{"$nulls":3},"体重",null,null,"检查者","医师意见：□\n\n签名："]
[null,"面部",null,"1正常□\n2其它□",null,"四肢",null,"1正常□\n2其它□"]
["内\n科","胸部透视",null,"1正常□\n2其它□",null,"其它",null,"1正常□\n2其它□","检查者","医师意见：□\n\n签名："]
["肝\n功","转氨酶",null,"  1正常□\n  2其它□",{"$nulls":3},"另附化验单",null,"医师意见：□\n\n签名："]
[]
["血\n液\n科","血常规",null,"  1正常□\n  2其它□",{"$nulls":3},"另附化验单",null,"医师意见：□\n\n签名："]
["体\n检\n医\n院\n意\n见","体检结论：\n            1合  格 □\n            2不合格 □\n                                                 体检医院（章）\n                                                   年   月   日"]
[]
["填表说明：",null,"A医师意见中填写意见代码，分别为1：合格，2：不合格"]
[null,null,"B申请人既往病史填写√"]