I, undersigned Doctor 医生的英文名, graduated inmedicine, certifies that 某先生或女士的英文名 (年龄 years old) is ableto participate in the sport of speed skating in competition.
PAPS TEST Personal Activity Preventive Screening Test 个人体育运动能力体检表
请在第3页《答题卡》中回答以下问题:
1、Has your doctor ever said that you have any heart issues and recommended that you only do sports under medical supervision? 你的医生说过你有心脏问题, 建议你只在医学监督下进行体育运动?
2、Have you ever had chest pains either at rest or during physical activity? 你曾经有过胸部疼痛吗? 无论是休息或在体力活动时?
3、Have you ever been diagnosed with heart murmurs or cardiac defects? 你曾经被诊断出心脏杂音或心脏缺损吗?
4、Do you have any problems breathing while resting or during physical activity? 你在休息或体力活动时有呼吸困难吗? 5、Do you have spells of severe dizziness or have you ever lost consciousness? 你有过严重的头晕或失去知觉吗? 6、Do you suffer from high blood pressure? 你患有高血压吗?
7、Do you have high lipid metabolism or cholesterol levels? 你患有高血脂或高胆固醇吗? 8、Do you have diabetes mellitus? 你有糖尿病吗?
9、Has your doctor ever prescribed medicine against high blood pressure or cardiovascular diseases? 医生给你开过治疗高血压或心血管疾病的药吗? 10、Has your doctor ever prescribed medicine for any heart conditions? 医生给你开过治疗心脏病的药吗?
11、Has your doctor ever prescribed medicine for breathing problems? 医生给你开过治疗呼吸问题的药吗?
12、Do you have asthma? 你有哮喘吗? | file:///C:\DOCUME~1\JOHNXU~1\LOCALS~1\Temp\msohtmlclip1\01\clip_image002.gif | file:///C:\DOCUME~1\JOHNXU~1\LOCALS~1\Temp\msohtmlclip1\01\clip_image002.gif |
13、Do you have any bone or joint problems that are made worse by increased physical activity? 你是否有任何骨骼或关节问题, 这种问题在增加体力活动时变得更糟? | file:///C:\DOCUME~1\JOHNXU~1\LOCALS~1\Temp\msohtmlclip1\01\clip_image002.gif | file:///C:\DOCUME~1\JOHNXU~1\LOCALS~1\Temp\msohtmlclip1\01\clip_image002.gif |
14、Have you ever felt like your heart is beating fast or irregularly, or that it is racing, either at rest or during physical activity? 你是否曾经感觉到你的心跳加快或心率不齐?无论是休息或体育活动时? | file:///C:\DOCUME~1\JOHNXU~1\LOCALS~1\Temp\msohtmlclip1\01\clip_image002.gif | file:///C:\DOCUME~1\JOHNXU~1\LOCALS~1\Temp\msohtmlclip1\01\clip_image002.gif |
15、Have any close relatives under the age of 60 died from a heart attack? 你的血缘近亲属中有不满60岁死于心脏病的吗? | file:///C:\DOCUME~1\JOHNXU~1\LOCALS~1\Temp\msohtmlclip1\01\clip_image002.gif | file:///C:\DOCUME~1\JOHNXU~1\LOCALS~1\Temp\msohtmlclip1\01\clip_image002.gif |
16、Does anyone in you family have diabetes mellitus? 你的血缘近亲属中有人患糖尿病吗? | file:///C:\DOCUME~1\JOHNXU~1\LOCALS~1\Temp\msohtmlclip1\01\clip_image002.gif | file:///C:\DOCUME~1\JOHNXU~1\LOCALS~1\Temp\msohtmlclip1\01\clip_image002.gif |
17、Has anyone in your family suffered sudden cardiac death? 你的血缘近亲属中有人突然因心脏病死亡吗? | file:///C:\DOCUME~1\JOHNXU~1\LOCALS~1\Temp\msohtmlclip1\01\clip_image002.gif | file:///C:\DOCUME~1\JOHNXU~1\LOCALS~1\Temp\msohtmlclip1\01\clip_image002.gif |
18、Do any of your close relatives have any heart conditions or illnesses? 你的血缘近亲属中有人患心脏疾病吗? | file:///C:\DOCUME~1\JOHNXU~1\LOCALS~1\Temp\msohtmlclip1\01\clip_image002.gif | file:///C:\DOCUME~1\JOHNXU~1\LOCALS~1\Temp\msohtmlclip1\01\clip_image002.gif |
19、Is there a family history of high blood pressure? 你有高血压家族病史吗? | file:///C:\DOCUME~1\JOHNXU~1\LOCALS~1\Temp\msohtmlclip1\01\clip_image002.gif | file:///C:\DOCUME~1\JOHNXU~1\LOCALS~1\Temp\msohtmlclip1\01\clip_image002.gif |
20、Has anyone in your family had a stroke? 你的血缘近亲属中有人患中风吗? | file:///C:\DOCUME~1\JOHNXU~1\LOCALS~1\Temp\msohtmlclip1\01\clip_image002.gif | file:///C:\DOCUME~1\JOHNXU~1\LOCALS~1\Temp\msohtmlclip1\01\clip_image002.gif |
21、Have you even been in the hospital for any non-orthopaedic or non-accident-related reasons? 你是否因非事故原因住过医院? | file:///C:\DOCUME~1\JOHNXU~1\LOCALS~1\Temp\msohtmlclip1\01\clip_image002.gif | file:///C:\DOCUME~1\JOHNXU~1\LOCALS~1\Temp\msohtmlclip1\01\clip_image002.gif |
22、Do you smoke? 你现在吸烟吗? | file:///C:\DOCUME~1\JOHNXU~1\LOCALS~1\Temp\msohtmlclip1\01\clip_image002.gif | file:///C:\DOCUME~1\JOHNXU~1\LOCALS~1\Temp\msohtmlclip1\01\clip_image002.gif |
23、Have you smoked in the past? 你过去吸烟吗? |
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24、Do you take any regular medicines (except contraceptive)? 你是否服用常规药物 (避孕药除外)? |
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25、Do you have any chronic illnesses, which have hindered you from in exercising in the past? 你是否患有慢性病, 这些疾病妨碍了你过去的运动? |
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26、Are you male (M) / female (f) ? 你的性别:男 女 | file:///C:\DOCUME~1\JOHNXU~1\LOCALS~1\Temp\msohtmlclip1\01\clip_image002.gif | file:///C:\DOCUME~1\JOHNXU~1\LOCALS~1\Temp\msohtmlclip1\01\clip_image002.gif |
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27、How old are you? 你的年龄? |
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28、What is your weight? 你的体重? |
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29、What is your size? 你的身高? |
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30、If you are already physically active, how long have you been doing sports? 如果你现在经常锻炼身体, 你坚持多少年了? |
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31、I am training __ hours/week (please round with an exactness of 30 minutes) 你每周锻炼多少小时? |
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32、How long ago did you last get checked to see if you are in sufficient physical condition to be doing sports (sports check-up)? |
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