照片
照片檔用於學籍資料表與學生證製作:1、本系統已有照片檔案者,如您要更換照片,請點選「更換照片」上傳檔案,照片更換期限為108年8月14日(星期三),超過期限,將使用原照片製證。 2、沒有照片檔案者,待您上傳符合規定之照片檔案,方可製證。
照片檔案規格:
1、脫帽之證件照或大頭照。
2、臉部正面朝向相機(不可仰頭或低頭),眼睛直視相機鏡頭。
3、照片背景為單一白色或藍色。
4、不接受生活照。
5、檔案大於50kb。
郵遞區號
地址
郵遞區號
地址
連絡人
郵遞區號
地址
個人過去病史:勾選本人曾患過的疾病 Medical
History
*若有下述特殊疾病尚未痊癒或仍在治療中,請主動告知並提供就診病歷摘要,以作為照護參考
If you are being treated for or
recovering
from any of the
following or some other disease, please inform the medical personnel and also
provide your medical records for the healthcare professional's
references.
Thalassemia
以下最多輸入五項,請用 "," 隔開
(Accept 3 Options, please use ',' to
split diffrent Options)
癌症 Cancer
過敏 Allergy
to
重大手術 Major
surgery:
其他疾病
Other
心理或精神疾病
Psychological or mental illness
特殊疾病現況或應注意事項 Condition of specific
ailments
幾週一次 How many week
once
幾月一次 How many month
once
幾年一次 hoe many year
once
Holder of Catastrophic Illness
Certificate-Category
(Accept 5 Options, please use ',' to split
diffrent Options)
類別 Option
類別 Option
(Accept 3 Options, please use ',' to
split diffrent Options)
家屬稱謂 Relative
with hereditary disease
疾病名稱 Name of
disease
生活型態 Life style
How much did you sleep during the
past 7 days (not including weekends, or days off)
How many days did you eat breakfast
during the past 7 days
幾天
days
(請輸入 1-6 , please keyin
1-6)
幾點吃 Every
day at(time)
(請輸入 0-23 , please keyin
0-23)
During the past month (not including
weekends. day's off, or winter or summer vacation),
have you exercised three times a week for at least 30 minutes each time, and
achieving a heartbeat rate of 130 bpm each time?
During the past month, did you smoke?
每天幾支 cigarettes
per day
(請輸入 1-100 , please keyin
1-100)
During the past month, did you drink
alcohol?
每天幾杯 glasses per
day
(請輸入 1-100 , please keyin
1-100)
During the past month, did you chew betel
quid?
每天幾粒 Lits per
day
(請輸入 1-100 , please keyin
1-100)
Do you feel worried or depressed ?
Do you regularly feel chest discomfort ?
Do you regularly feel stomach discomfort ?
Do you regularly have headaches ?
Menstrual history(women only)
初經年齡 first
period age
Bowel habits: During the past 7 days, how
often did you
defecate?
Internet use: During the past seven days
(not
including weekends, or days off), how many hours did you use the internet every
day, apart from when doing homework or in class?
自我健康評估 Selfrated Health
For the past month, what do you think of
your plıysical state?
For the past month, what do you think of
you mental state?
Do you have any health-related probleins?
Please describe:
體檢諮詢專線:03-5712121#51104 黃小姐
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於確認資料均正確無誤後,請勾選下列選項並按[送出],即可下載報到單。
(未服役男生確認資料即已完成兵役緩徵申請作業)