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{"sheet":"健康告知","index":0,"n_rows":40,"n_cols":6,"rows_kept":40}
[null,"重疾\\医疗\\意外通用"]
[1,"您是否已投保友邦保险之外的其他保险公司人身保险合同?","A是","B否"]
[2,"您的人寿保险、意外伤害保险或健康保险的新单申请或复效申请是否曾被拒保、推迟、加费或作任何形式修改?","A是","B否"]
[3,"您是否曾向除本公司以外的其他保险公司提出过癌症、重疾、伤残或住院医疗的索赔申请?","A是","B否"]
[4,"您是否正在或试图参加私人性质飞行，或携带氧气瓶潜水、或登山、或从事危险性的运动?若“是”，请填妥相关问卷，连同此投保单一并交回本公司","A是","B否"]
[5,"您是否正计划前往其他国家或海外地区旅行，工作或居住;且持续时间超过三个月?若“是”，请详述时间及具体前往的国家/海外地区","A是","B否"]
[6,"身高体重变化","A是","B否","身高：",0]
[7,"是否曾或正在接受或准备接受药物治疗、外科手术或服用药物?","A是","B否","体重：",0]
[8,"过去五年是否曾接受健康检查(包括血检、肿瘤标志物、X光、心电图、超声波等检查)且结果异常?","A是","B否","过去一年内体重:",0]
[9,"过去五年是否曾接受或被建议进行CT、核磁共振、核素扫描、病理检查、内窥镜、脑电图、心血管造影等特殊检查?","A是","B否"]
[10,"过去五年是否曾接受诊疗、外科手术、住院治疗","A是","B否"]
[11,"是否有身体残障状况:四肢、五官、手指、足趾缺损","A是","B否"]
[12,"是否有身体残障状况:视力、听力、语言能力或中枢神经系统障碍","A是","B否"]
[13,"是否有身体残障状况:脊柱、胸廓、四肢或手指、足趾畸形、跛行、脊髓灰质炎所致的缺陷及其它缺陷","A是","B否"]
[14,"是否曾有下列症状、曾被告知患有下列疾病或因此接受治疗：反复头晕、反复头痛、晕厥、胸闷、胸痛、心慌、气急、不能平卧、紫绀、不明原因发热或持续反复发热、抽搐、不明原因皮下出血点、鼻蚰、反复齿龈出血、咯血、反复呕吐、进食梗噎感或吞咽困难、呕血、浮肿、腹痛、肝区疼痛、黄疸、便血、排便习惯或大便性状改变、血尿、蛋白尿、肿块、眼睛胀痛、视力或听力明显下降、视物不清、不明原因的声嘶、关节红肿、关节酸痛","A是","B否"]
[15,"是否曾有或被告知患有眼、耳、鼻、喉或口腔的疾病或因此接受治疗","A是","B否"]
[16,"是否曾有下列症状、曾被告知患有下列疾病或因此接受治疗：癫痫、重症肌无力、肌营养不良症、多发性硬化症、帕金森氏综合症、肌肉萎缩、脊髓灰质炎、精神病、聋哑、四肢机能障碍、下肢静脉曲张、智能障碍及其它各种类型畸形或残缺","A是","B否"]
[17,"是否曾有下列症状、曾被告知患有下列疾病或因此接受治疗：血管畸形、脑动脉血管瘤、视网膜出血或剥离、视神经病变、虹膜睫状体炎、青光眼、白内障、失明、局度近视800度以上、眼底病变","A是","B否"]
[18,"是否曾有下列症状、曾被告知患有下列疾病或因此接受治疗：慢性支气管炎、哮喘、肺脓肿、肺栓塞、胸膜炎、肺气肿、支气管扩张、肺结核、尘肺、矽肺","A是","B否"]
[19,"是否曾有下列症状、曾被告知患有下列疾病或因此接受治疗：高血压病、缩窄性心包炎、心内膜炎、风湿性心脏病、先天性心脏病、缺血性心脏病、心肌梗塞、心肌肥厚、主动脉血管瘤、脑血管意外、心律失常、心肌病","A是","B否"]
[20,"是否曾有下列症状、曾被告知患有下列疾病或因此接受治疗：肝炎病毒携带者、肝硬化、肝脓肿、肝内结石、肝炎、肝脾肿大、脂肪肝、肝吸虫感染、胆囊炎、胆结石、化脓性胆管炎、消化道溃疡、出血及穿孔、溃疡性结肠炎、胰腺炎、肛管疾病、疝气","A是","B否"]
[21,"是否曾有下列症状、曾被告知患有下列疾病或因此接受治疗：肾炎、肾病综合征、肾功能异常、尿毒症、肾囊肿、肾下垂、尿路结石、尿路畸形","A是","B否"]
[22,"是否曾有下列症状、曾被告知患有下列疾病或因此接受治疗：糖尿病、痛风、肢端肥大症、垂体机能亢进或减退、甲状腺或甲状旁腺机能亢进或减退、甲状腺结节、肾上腺机能亢进或减退等内分泌系统疾病","A是","B否"]
[23,"是否曾有下列症状、曾被告知患有下列疾病或因此接受治疗：恶性肿瘤、或尚未证实为良性或恶性的肿瘤、息肉、囊肿、赘生物","A是","B否"]
[24,"是否曾有下列症状、曾被告知患有下列疾病或因此接受治疗：血友病、白血病、各类贫血、紫癜及其它各种类型的血液系统疾病、被建议不宜献血","A是","B否"]
[25,"是否曾有下列症状、曾被告知患有下列疾病或因此接受治疗：风湿性关节炎、类风湿性关节炎、系统性红斑狼疮、胶原症、硬皮病及其他自身免疫性疾病","A是","B否"]
[26,"是否曾有下列症状、曾被告知患有下列疾病或因此接受治疗：胸、颈、腰椎骨疾病及其它骨骼系统疾病","A是","B否"]
[27,"是否曾有下列症状、曾被告知患有下列疾病或因此接受治疗：性病、酒精或药物滥用成瘾、各种眩晕症","A是","B否"]
[28,"是否还有其它以上未提及的疾病及症候","A是","B否"]
[29,"您或您的配偶/父母曾接受或试图接受与艾滋病（AIDS)有关的医疗咨询、检验或治疗。曾在过去6个月内持续一周以上有下列症状：体重下降、食欲不振、盗汗、腹泻、淋巴结肿大及皮肤溃疡","A是","B否"]
[30,"您的家属(父母、兄弟姐妹)曾患有或正患有心脏病、多囊肾、肠息肉、糖尿病、癌症","A是","B否"]
[31,"您的直系亲属中是否有60岁前因疾病去世的","A是","B否"]
[32,"您是否吸烟或曾吸烟","A是","B否"]
[33,"您是否饮酒或曾饮酒","A是","B否"]
[34,"您是否曾接到医生对您饮酒、吸烟的建议和警告?","A是","B否"]
[35,"有无体检资料或病历资料提供","A是","B否"]
[36,"您是否正处于妊娠期","A是","B否","女性独有"]
[37,"您是否患有乳腺炎、乳房肿块、子宫内膜异位症、子宫肌瘤、卵巢囊肿、阴道异常出血、性传播疾病或其他生殖器官疾病","A是","B否","女性独有"]
[38,"您是否曾被建议重复宫颈涂片检查、乳房检查、乳房X光或活体检查","A是","B否","女性独有"]
[39,"您的家庭成员中是否有人患过乳腺癌","A是","B否","女性独有"]