SBARRREER —__ PHYSICAL EXAMINATION RECORD FOR FOREI ‘SULAIMAN ft | vonammeo | th WHMale [uh Name | AHMEDMOGALLI | Sex [4c Female | Birth 12 /May./ 1993 a" Algeria /Skikda / Athadaik /First university ma %& Pe bleed residence / Pavilion 2 Room 39 Blood Type tas Postal code 21130 itt ie te o Nationality | “m=! Birth Pisce | BO” YEMEN WEEGEA Posewis CETUE MINS “A” Bh OE") Have you ever had any of the following diseases? (Each item must be answered “Yes” or “No” ) BE % fi H Typhus fever WNoll¥es AUER TESHIR Bacillary dysentery MNoL¥es JUARHTE Poliomyelitis NC Yes 77 RFFEAE Brucellosis GANoL Yes a 1% Diphtheria GHNoL Yes _#iELENT-HL Virall hepatitis GINoLYes| #2 MH BScarlet fever NoL Yes _P*HAAHEERIT Puerperal streptococcus NOD Yes FH 4K Relapsing fever [BNoCI¥es I JR infection TINoL¥es ‘RATE GDR Typhoid and paratyphoid fever TaNoD Yes WATHEMOHABLR Epidemic cerebrospinal meningitis GNoLI Yes: RERATHELALBRALSME: COWES. “8” RR”) Do you have any of the following diseases or disorders endangering the public order and secure? (Each item most be answered “Yes” or “No” ) ORE. Toxicomania ses NO: JA}HEEL Mental confusion « ‘NO {AI Psychosis: BREE! Manic paychosissss+sesses 32H Paranoid psychosis: ‘QM Hallucinatory psychosi HF Bi/Height (HEK/ em) 18 Hi) Weight (AFT ke) iit FK/pressure Blood @E>K Ae HE:/mmlg) 167 6 ‘80/120 ARTE. Development ‘EFFATR Nourishment StH Neck NORMAL NORMAL. NORMAL wy | EE tone rman ze Hl Byes eat Vision Corrected vision ARWAD 4 R_NORMAL ‘BF & 7alColor sense BE/Skin EK /Lymph nodes NORMAL NORMAL NORMAL years BINose ‘At S/Tonsils NORMAL ‘NORMAI NORMAL b/Heart a /Lungs NORMAL | [Bf3/Abdomen SOFT AND NORMAL. NORMALHEARTSOUND _ | VESICULAR BREATH WH: 42 C19X27cem)‘A KH Nervous system NORMAL “SUT ML/Other abnormal findings NORMAL (NO ABNORMAL FINDINGS) WARE X 2248 #E/Chest X-ray exam HL VECG NORMAL NORMAL Fee Ss ET Ls. ML FIE BTL at Exam (HIV, Syphilis Serodiagnosis) SRL AF UREA LRU AE ZI IB None of the following diseases or di ee found during the present examination. # AL Cholera (NO) $i Venereal Disease (0) BUARE Yellow fever (NO) aknertin Opening lung tuberculosis (Ae) BL WR Plague (NO) xX 4 AIDS (wo) WE FA Leprosy «Noy Ho #F A Psychosis (Af0) =x ‘Suggestion From the history, examiriation and lap. He is normal and fit for study and work. & yy, es, a wana, Official pe Signature of physician SS. 42 C19X27em)Jalid Abro: Translation from French Valid Ab L.L.C. Clinic Abu_Al_Qassim Skikda LLC. witha Capital of 160.000,000 DA a7 General Surgery: Infantile Surgery- Urology - Obstetrics /Gynaecology — Oto-Rhino-Laryngology - Ophthalmic- Orchopedics/ Traumatology - Laboratory- Medical Imagery ~ Podiatric- Psychology P f Date: January 28", 2019 Name: MOGALLI N* ANL/2019/02095 Forename: Sulaiman Mohammed Ahmed Attending Physician: Test Nb. “Test Value Reference Value Ag- HBS Negative Newative _HCV-1gG a Negative Negative HIV : Negative Negative BW Negative Negative —_TGO 5 20.90 inf. 40.0 vill TGP 1438 ink, 40.0 uill Biologist physician: Dr. AKLOUF Mohamed legible signature Followed by a rectangular stamp enclosing Sarl (LLC) ABU_AL_QASSIM CLINIC Dr. AKLOUF Mohammed Specialist Doctor in Clinical BiologyTranslation from French CLINIQUE ABU-AL-QaSSIM Medical Imaging Center Skikda, On: January 24'*, 2019 Name: MOGALLI Forename: Sulaiman Mohammed Ahmed Age: 25 years old Attending physician: Dr. [2 MEDICAL REPORT é oe je | FACE THORAX X-ray Results; © Absence of Parenchymal lesion. ¢ Standard size of hilus. + Mediastinum elements in place. * Heart shadow without anomaly. © Free pleural pouch. + Absence of osseous lesion, Conclusion: X-ray examination within normal limits. Dr A.HALLED] legible Signature Followed by an oval stamp enclosing: L.L..C Clinique Abu-Al-Qassim - Skikda Dr. HALLADJA Abdelkader Radiologist Les allées du 20 aoat 1955, Skikda (Alga 35/72 20 20 Fax: +213 (0) 3872 1616