User Guide for Health Screening Program 體格檢查指引 Please bring along this User Guide to the clinic for identification. 請擕同本 體格檢查指引 往診所作証明之用 Note : Please tick the appropriate box. 註 : 請在適當的空格內填上 號 Name of Company: Staff Association of The Chinese University of Hong Kong (Vio code: CUSA 01) 公司客戶名稱 Teacher s Association of The Chinese University of Hong Kong (Vio code: CUTA 01) Name of Examinee: 受檢查者名稱 Name of related Staff: 有關職員姓名 HKID./Passport No.: 身份証 / 護照號碼 HKID./Passport No.: 身份証 / 護照號碼 Relationship with Staff 與職員之關係 : Staff 職員 Spouse 職員配偶 Children 職員子女 Plan A Plan B Plan C Plan D Plan E Recommended for Recommended for Recommended for over 50 (Male) over 50 (Female) aged over 60 (Male) 建議 50 歲以上 ( 男士 ) 建議 50 歲以上 ( 女士 ) 建議 60 歲以上 ( 男士 ) Recommended for aged below 50 建議 50 歲以下人士 V439 $700 per exam/ 每次 V440 $1200 per exam/ 每次 V444 $1045 per exam/ 每次 V441 $1300 per exam/ 每次 Recommended for aged over 60 (Female) 建議 60 歲以上 ( 女士 ) V442 $1150 per exam/ 每次 Chosen Clinic 選擇診所 : Central 中環 / TST 尖沙咀 / Tsuen Wan 荃灣 Appointment (date and time) 預約日期和時間 : 1. Servicing Centers 服務中心 Central 中環 Room 418 Prince s Building 10 Chater Road 遮打道 10 號太子大廈 418 室 Mon Fri 8:30 am to 6:30 pm Sat 8:30 am to 1:00 pm Tel: 2521-3302 Tsimshatsui 尖沙咀 9/F. Kaiseng Comm. Centre 4-6 Hankow Road 漢口道 4-6 號騏生商業中心 9 字樓 Mon Fri 8:30 am to 6:30 pm Sat 8:30 am to 1:00 pm Tel: 2369-3329 Tsimshatsui 荃灣 Unit 712 Nan Fung Center 264-298 Castle Peak Road 青山道 264-298 號南豐中心 7 樓 712 室 Mon Fri 9:00 am to 1:00 pm 3:00 pm to 6:30 pm Sat 9:00 am to 1:00 pm Tel: 2415-6777 Page 1 of 6
2. Identification 証明文件 This User Guide is used for identification at clinic. Failure to present this User Guide, Dr. Vio & Partners reserves the right NOT to offer this special discount. 本 體格檢查指引 將用作享有此優惠的証明 倘閣下未能出示本 體格檢查指引, 韋予力醫生醫務所保留不給予優惠的權利 3. Procedures 程序 i) Please make appointment in advance before obtaining any health services. 請自行與診所預約 ii) When making appointment, please indicate to the following to the clinic staff: 預約時, 請向診所職員說明下列各項.. a) Company Name (CUSA / CUTA) and Vio Company Code 公司名稱及公司編號 (1) Staff Association of The Chinese University of Hong Kong (Vio code: CUSA 01) (2) Teacher s Association of The Chinese University of Hong Kong (Vio code: CUTA 01) b) Health Check code 體格檢查編號 d) Member Name 會員姓名 iii) Please record your own appointment date and time. 請自行記錄檢查日期和時間 iv) Please be fasting at least 8 hours before the examination. NO food or drink is allowed except for water. 檢查前, 請空腹最少 8 小時 不可進食, 只可飲清水 v) Please bring stool specimen to the clinic for laboratory use. 請帶大便樣本供化驗用 Additional Information 附加資料 Female examinees prefer to take health check NOT during the menstruation period. 女性應避免於生理期間進行身體檢查 If you have recently taken any diagnostic examination, please bring along report(s) to the clinic for comparison. 如在近期曾接受任何醫學檢查, 請於約見醫生時帶同檢查報告以供比較 Please bring along medication taken regularly 請帶同經常服用的藥物 vi) When registration, please present the following to the clinic staff: 登記時, 請出示向診所職員出示下列文件 ; a) this User Guide 本體格檢查指引 b) HKID 身份証明 vii) The following procedures shall be completed in the first visit. 首次到診, 將完成下列各項程序 : a) Medical Questionnaire 體格檢查問卷 - Dr. Vio standard medical questionnaire - CUSA and CUTA Supplementary Health Questionnaire b) Biometric measurement by nursing staff 生物量度 c) X-ray and laboratory investigations X 光和化驗 viii) Please make the second appointment immediately before leaving the clinic. 離開診所前, 請自行預約第 2 次醫生會診時間 Page 2 of 6
ix) During the second visit, the following procedures shall be completed. 第 2 次到診, 將完成下列各項程序 : a) Physical examination by a doctor 體格檢查 ( 由醫生執行 ) b) Explanation of results on x-ray and laboratory investigations 解釋 X 光檢查和化驗報告 4. Medical Examination Report 體格檢查報告 The Medical Examination Report shall be sent to the respective examinee within 14 working days after completing the examination. 體格檢查報告將於完成所有檢查後的 14 個工作天內郵寄予檢查者 5. Enquiry 查詢熱線 CUSA 香港中文大學職員協會 Ms. Cecilia Wong 黃小姐 Tel: 2603-6600 Dr. Vio & Partners 韋予力醫生醫務所 Ms. Lo 盧小姐 Tel: 2200-9382 Ms. Leung 梁小姐 Tel: 2200-9336 Page 3 of 6
Physical Health Check 體格檢查 Investigations 檢查部份 Detailed Medical History 詳細病歷資料 Physical Examination by Doctor 體格檢查 Height and Weight 高度 體重 Blood Pressure and Pulse 血壓 脈搏 Eyesight Test and Color Vision 視力及辨色測試 Waist Measurement 腰圍 Chest X-ray 胸肺 X 光 ECG 心電圖 Laboratory Investigations 化驗項目 血液檢查 Blood Picture 肝功能 Liver Function 糖尿病 Diabetes Screening 冠心病率檢查 Cardiovascular System 痛風症檢查 Gout Screening 腎臟功能 Renal System 甲狀腺功能 Thyroid Gland 癌標法 Cancer Screening 大便常規檢查 Stool Routine Complete Blood Count ( CBC ) 全血球計數 Alk. Phosphatase 鹼性磷酸 Fasting Blood Glucose 血糖 ( 空腹 ) Purposes 檢查目的 了解過往健康情況 Plan A Plan B Plan C Plan D Plan E below 50 V439 over 50 Male V440 over 50 Female V444 over 60 Male V441 over 60 Female To review the past medical history 檢查任何病狀 To look for clinical sign 了解身體是否有體重問題 To identify the weight problems 了解身體是否有血壓問題 To identify the blood pressure problems 檢查視力及辨色能力是否正常 To identify the eyesight problems 檢查是否有 抗胰島素 現象 To identify the risk of metabolic syndrome 查出如肺結核的不正常陰影 To detect abnormal shadow such as tuberculosis 測試心律不齊, 先天性心臟病及冠心病等疾病 To detect Arrhythmia, congenital heart disease and coronary heart disease Purposes 檢查目的 可了解身體有否貧血 白血球過多或過少 以及血液病的可能性 To identify the risk of Anaemia, abnormal white cell counts or some other blood disorders V442 SGPT/ALT 谷丙轉氨酵素測定肝功能 To identify the risk of liver function disorder 檢查糖尿病和一些血糖的疾病 To identify the risk of Diabetes Mellitus or low blood sugar Cholesterol Total 總膽固醇 Cholesterol, HDL 高密度膽固醇能發生動脈硬化及冠狀動脈硬化性心臟病 Cholesterol, LDL 測定血液內膽固醇的指標 長期偏高, 則有可 To check cholesterol level. High cholesterol may 低密度膽固醇 lead to atherosclerosis, hypertension, stroke and coronary heart disease Triglycerides 三酸甘油脂 Uric Acid 尿酸 Urine Routine (macro and micro) 小便檢查 ( 常規及微檢 ) 若長期尿酸偏高, 則會引起痛風症而導致關節 骨骼的疼痛及變形 To identify the risk of gout 可了解尿中有否蛋白 糖 血尿 尿道炎及膀胱炎等症狀 To identify the risk of kidney function disorder, urinary tract and infection 測定有關腎功能的疾病 尿道炎 腎炎及腎石 Creatinine 肌酸酐 To identify the risk of kidney disease, urinary Urea 尿素 tract infection, nephritis and renal stone T4 甲狀腺素 Prostatic specific antigen total (PSA) (male) 前列腺癌抗原 ( 男性 ) Ova, parasite and occult blood 寄生蟲及隱血 測知甲狀腺分泌功能亢進減退所致的疾病 To identify the risk of hyper or hypo thyroidism 檢驗前列腺癌 To identify the abnormal cells in the prostate 檢查糞便中是否有蟲卵, 寄生蟲等 隱血測試則顯示有否腸胃出血及其他相關疾病 Test for the present of ova and parasite, Occult blood test for internal bleeding in intestine and other related disease. Follow-Up Consultation 醫生跟進會診 (explanation of laboratory results 解釋化驗報告 ) Report with Doctor s Comments 報告連醫生意見 Special Rate (HKD per exam) 優惠價 ( 港幣每次 ) $700 $1200 $1045 $1300 $1150 Page 4 of 6
Optional Tests for Physical Health Check 附加檢查項目 Remarks: at extra charge (must be done with the above health check) 註..另行收費 ( 須與上述體格檢查同時進行 ) Chest X-Ray ECG Investigations 胸肺平片 心電圖 化驗項目 Pelvis Ultrasound (female) 盤腔超聲波 ( 女性 ) Breast Ultrasound (female) 乳房超聲波 ( 女性 ) Mammogram (female) 乳房 X 光造影 ( 女性 ) Ultrasound for specific local area 指定局部超聲波 Ultrasound for upper abdomen Treadmill Exercise Stress Test 上腹超聲波 運動心電圖 骨質密度普查 Bone Density Screening - DEXA DEXA 雙能量 X 光吸收測 (hip & spine) 量 ( 髖關及腰椎 ) Gastroscopy Colonoscopy (Dr. Fee) Barium Enema Intravenous Pyelogram (IVU) Cardiovascular System 冠心病率檢查 Gout Screening 痛風症檢查 Liver Function Group Test 肝臟功能 胃鏡 大腸鏡 腸鋇造影 靜脈腎盂泌尿系統造影 Cholesterol Total 總膽固醇 Cholesterol, HDL 高密度膽固醇 Cholesterol, LDL 低密度膽固醇 Triglycerides 三酸甘油脂 Uric Acid 尿酸 SGPT/ALT 谷丙轉氨酵素 SGOT/AST 谷草轉氨酵素 Alk. Phosphatase 鹼性磷酸 Bilirubin, Total 總膽紅素 Gamma GT 丙種谷氨轉酵素 Purposes 檢查目的 查出如肺結核的不正常陰影 To detect abnormal shadow such as tuberculosis 測試心律不齊, 先天性心臟病及冠心病等疾病 To detect Arrhythmia, congenital heart disease and coronary heart disease 測定是否盤腔有腫瘤 To detect fibroid or cysts in the pelvis 測定乳房是否有腫瘤 To detect lumps in breast 測定乳房是否有腫瘤 To detect lumps in breasts 測定是否有腫瘤 To detect lumps in a specific part of body 測定上腹是否有腫瘤 To detect lumps in upper abdomen 測試心律不齊, 先天性心臟病及冠心病等疾病 To detect Arrhythmia, congenital heart disease and coronary heart disease 檢查是否有骨質疏鬆症, 以便減低骨折的機會 To identify the risk of Osteoporosis to prevent the risk of bone fracture 檢查胃部有否潰瘍 息肉或腫瘤 To detect any stomach ulcer, polyp or cancer 檢查大腸有否息肉或腫瘤 To detect any colonic polyp or cancer 檢查大腸有否息肉或腫瘤 To detect any colonic polyp or cancer 檢查泌尿系統是否有腎石 阻塞或狹窄 To detect any renal stone, obstruction or structure in the urinary tract 測定血液內膽固醇的指標 長期偏高, 則有可能發生動脈硬化及冠狀動脈硬化性心臟病 To check cholesterol level. High cholesterol may lead to atherosclerosis, hypertension, stroke and coronary heart disease 若長期尿酸偏高, 則會引起痛風症而導致關節 骨骼的疼痛及變形 To identify the risk of gout 測定肝功能 To identify the risk of liver function Page 5 of 6 Vio Code 編號 Special Price 優惠價 XRY202 $150 PRC002 $200 XRYI007 $580 XRY133 $680 XRY102 $680 XRY136 $680 XRYI001 $680 PRC020 $1440 XRY169 $850 PRC203 $2000 GEN050 $5500 XRY103 $1300 XRY100 $1260 LABC39 $135 LABC58 $35 LABG46 $200 Investigations 化驗項目 Purposes Vio Code Special Price
檢查目的編號優惠價 Thyroid Gland 甲狀腺功能 糖尿病 Diabetes Screening 性病 Venereal Disease 癌標法 Cancer Screening 肝炎測試 Hepatitis Screening 肝炎疫苗 Hepatitis Vaccination T4 (aged over 60 ) 甲狀腺素 ( 超過 60 歲 ) LABR44 $80 TSH level 促甲狀腺激素 LABR46 $160 Free Thyroid Group Test - Free T3 - Free T4 - TSH Glucose 血糖 HIV (1 & 2) Antibody 愛滋病 (1 及 2 型 ) 抗體 Pap Smear (Thin Prep Pap Test) (female) 柏氏塗片檢查 ( 女性 ) Ovary (female) CA125 卵巢 ( 女性 ) CA125 Prostatic specific antigen total (PSA) (male) 前列腺癌抗原 ( 男性 ) Pancreas CA 19.9 胰 CA19.9 EB virus antibody NPC 鼻咽癌 NPC Colorectal CEA 腸 CEA Alpha-fetoprotein 甲種胎兒蛋白 Hepatitis A virus antibody, total 總甲型肝炎抗體 Hepatitis Bs antibody and Hepatitis Bs antigen 乙型肝炎表面抗體及乙型肝炎表面抗原 Hepatitis A vaccine 甲型肝炎疫苗 (a course of 2 injection) Hepatitis B vaccine 乙型肝炎疫苗 (a course of 3 injection) Combined Hepatitis A & B injection 甲乙型混合肝炎疫苗 (a course of 3 injection) 可測知甲狀腺分泌功能亢進減退所致的疾病 To identify the risk of hyper or hypo thyroidism 檢查糖尿病和一些血糖的疾病 To identify the risk of Diabetes Mellitus or low blood sugar 檢查愛滋病的疾病 To identify the risk of HIV infection 偵測子宮頸細胞異常增生和早期子宮頸癌 To detect cancer of the cervix or precancerous conditions 檢查是否患有卵巢癌的可能 To identify the risk of ovary cancer 檢驗前列腺癌 To identify the abnormal cells in the prostate 檢查是否患有胰臟癌的可能 To identify the risk of pancreas cancer 檢查是否患有鼻咽癌的可能 To identify the risk of nasopharyngeal cancer 檢查是否患有腸癌的可能 To identify the risk of colorectal cancer 檢查是否患有肝癌的可能 To identify the risk of liver cancer 測定肝炎水平 跟據檢驗結果, 才注射疫苗 To check the hepatitis immunity level before vaccinations 增加抗體水平 Increase the immunity level LABG45 $480 LABC30 $35 LABR32 $170 LABB01 $240 LABR07 $288 LABR38 $250 LABR06 $288 LABH33 $280 LABR09 $160 LABR02 $160 LABR21 $150 LABR52 $210 VAC073 VAC068 VAC085 $340 per injection $150 per injection $360 per injection Page 6 of 6