1-6 (1) PEMERIKSAAN MATA (EYE) (i) Penglihatan (Vision): Mata Kanan (Right Eye) Mata Kiri (Left Eye) Dengan Kaca Mata (With glasses) 6/_ Dengan Kaca Mata (With glasses) 6/_ Tanpa Kaca Mata (Without glasses) 6/_ Tanpa Kaca Mata (Without glasses) 6/_ (ii) Penglihatan warna (Colour vision): Biasa (Normal) Luar Biasa (Abnormal) (iii) Juling (Squint): Ada (Present) Tiada (Absent) (2) PEMERIKSAAN TELINGA/ PENDENGARAN (EAR/ HEARING) (i) Pemeriksaan fizikal (Physical examination): Kanan (Right) Biasa (Normal) Luar Biasa (Abnormal) Kiri (Left) Biasa (Normal) Luar Biasa (Abnormal) (ii) Pemeriksaan Pendengaran (Hearing): Kanan (Right) Biasa (Normal) Luar Biasa (Abnormal) Kiri (Left) Biasa (Normal) Luar Biasa (Abnormal) (3) PEMERIKSAAN MULUT, KERONGKONG DAN GIGI (ORAL, THROAT AND TEETH) (i) Mulut (Oral): Biasa (Normal) Luar Biasa (Abnormal) (ii) Kerongkong (Throat): Biasa (Normal) Luar Biasa (Abnormal) (iii) Gigi/ Gigi palsu (Teeth/ Denture): Biasa (Normal) Luar Biasa (Abnormal) Catatan/ (Remark):
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