![](data:image/png;base64,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)
Huyện.............................
Hội đồng KSK NVQS
CỘNG HÒA XÃ HỘI CHỦ NGHĨA VIỆT NAM
Độc lập - Tự do - Hạnh phúc
---------------
Số: ................. ..................., ngày...tháng...năm...
Báo cáo kết quả khám sức khỏe nghĩa vụ quân sự
Năm ........
TT Nội dung Kết quả Ghi chú
1 Số lượng khám theo kế hoạch
2 Số lượng đã khám
3 Phân loại sức khỏe:
Loại 1
Loại 2
Loại 3
Loại 4
Loại 5
Loại 6
Nơi nhận:
- Sở Y tế ;
- Hội đồng NVQS huyện;
- Phòng Y tế huyện;
- Lưu.....
Chủ tịch Hội đồng khám sức khỏe
(Ký tên và đóng dấu)