![](data:image/png;base64,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)
Huyện.............................
Xã .....................................
CỘNG HÒA XÃ HỘI CHỦ NGHĨA VIỆT NAM
Độc lập - Tự do - Hạnh phúc
---------------
Số: ................. ..................., ngày...tháng...năm...
Báo cáo kết quả sơ tuyển sức khỏe nghĩa vụ quân sự
Năm ........
TT Nội dung Kết quả Ghi chú
1 Số lượng phải sơ tuyển sức khỏe theo
kế hoạch
2 Số lượng đã sơ tuyển
3 Số lượng đủ điều kiện khám tại tuyến
huyện
4 Tổng số đã loại ra
Trong đó:
- Số lượng đề nghị miễn làm NVQS
- Lý do khác
Nơi nhận:
- Hội đồng NVQS xã;
- Phòng Y tế huyện;
- Trung tâm Y tế huyện;
- Lưu.....
Tổ trưởng
Tổ sơ tuyển sức khỏe
(Ký tên)