3.放射线技师的声明[ Radiographer’s certification]

☆我证明我对该申请人实施了X光照射，并检查了该表格的照片和签字。

☆放射线技师的签名[Radiographer’s signature]

☆日期[Date]

D部分[Part D]——放射线专家完成[Radiologist to complete](个人理解是，放射线技师只管拍片子，而看片子上边有没有病是由放射线专家来完成)

☆请使用钢笔并用英文认真填写。字迹模糊者将被返还。

☆任何方面的不正常都应有纪录。[Comment is required on any and all aspects found not to be entirely normal]

☆(所有不正常的部分要给予详细地描述)[Give a full description of all abnormal findings]

1.骨骼和软组织[skeleton and soft issue]

☆正常[Normal]/不正常[Abnormal]

2.心脏投影[cardiac shadow]

☆正常[Normal]/不正常[Abnormal]

3.淋巴腺[lymphatic glands]

☆正常[Normal]/不正常[Abnormal]

4.半隔膜和肋骨膈角[Hemidiaphragms and costophrenic angles]

☆正常[Normal]/不正常[Abnormal]

5.肺部[lung fields]

☆正常[Normal]/不正常[Abnormal]

6.肺结核[evidence of TB]

☆未显示[Absent]/显示[Present]

7. 其他不正常情况 [Details of other abnormalities]

8. 放射线专家的声明[Radiologist’s declaration]

☆我声明我已经检查了X光片并真实记录了检查结果。

☆放射线专家签名，日期

☆全名(请认真填写)

☆地址，联系电话

☆放射线专家请注意: [To the Radiologist]

请将填写完毕的160表格放入附带的信封中。封上信封，并在封口处签名或盖上橡皮章。如果不在澳大利亚本土，请把这个信封附带X光片放入一个外层信封。如果在澳大利亚本土，就不用附带X光片。请把这个信封返还给：直接交给信封上表示的澳大利亚政府办事处，若没有标明地址交给申请人本人;或者若在澳大利亚本土检查的，根据HSA的地区安排。

E部分[Part E]——申请人完成[Applicant to complete]

在你参加放射线检查之前：[Before you attend the radiological examination]

在下表中填写姓名和住址[fill in your name and address in the space below]

回答下边的问题[complete the question below]

这个信封是关于谁的私人医疗档案：[this envelop contains private medical documentation concerning:]

☆姓[family name]

☆名[given name]

☆地址[address]邮编[postcode]

关于澳大利亚签证申请人[in relation to an application for an Australian visa]

☆这份关于放射线检查的申请是否已经提交澳大利亚政府办事处?[Has the application to which this radiological examination is related, already been submitted to an Australian Government office?]

☆没有[no]

如果在澳大利亚本土以外，在检查以后，放射线专家将把你的所有医疗文件放入这个信封(附带X光片)并交到你所提供的以上地址。[If outside Australia after your examination, the radiologist will place all your medical documents into this envelope and forward it to you, with the x-ray attached, at the address you have given above.]

当你提交签证申请时，请务必把这个未开封的信封和X光片一同提交[you must make sure that this unopened envelope and x-ray (if attached) accompanies the application for an Australian visa when it is submitted.]

如果你不是申请提交人，请务必把此信封和X光片交给申请人或者中介人。[If you are not the person submitting the application, make sure this unopened envelope and x-ray (if attached) is given to the person or agent who will be submitting the application.]

注意：如果你还没有提交申请，请注意填写A部分的问题7。[Note-if you have not lodged the application, ensure that Question 7 of Part A is complete.]

☆是的[Yes]

☆相关办事处的名称和地址[name and address of office concerned]

☆我的档案号是[my file number is]

一旦封口，该信封只能由医生小组或澳大利亚政府办事处在审核过程中开封。[Once sealed, this envelope is to be opened only by a panel doctor or the Australian Government office processing the application]