124
"O.,
WEIGHT
PAST
— aE, SEX
HISTORY
eee
ON JUR LES
CENTIMETERS
BLOOD PRESSURE
HEART
&
LUNGS
ABDOMEN
EENT
Gu or Gyn
SKIN
1055
iF
1056
Aaah #
105T
LF
1058
LM
1503
6M
1504
2M
Seres on
nostrils; no hx.
of sig. '64
Polio (1) date?;
no sig. Sistory
aside from leg
pains "6b
15#
No a
3-1/2 #|
Nom
30-1/4
96.1
2801/4
85.2
78/58
Gr I apical sys
Scars
a
Gr I apical sys
m
pe
1M