114 "0. , AGE, SEX WEIGHT PAST HISTORY weer INJURIES CENTIMETERS BLOOD PRESSURE HEART & ABDOMEN LUNGS EENT Gu or Gyn — 912 uM 913 13M ag 16 M 921 10 M fe significant history '6% 58 130.8 No nx. '64 7 138.0 Swelling of rt. wrist; abd. TT-1/2 pain '62 150 URI ‘64 56-1/4 125.0 98/56 SKIN | | Ant. cervical nodes} parotids do not seem enlarged 106/64 Gr I sya m '62; nom, My split Clear Genitalia 2 Sears of impetigo in '64 80/50 208/50 Gr I sys a Tonsils += ; | f t + 923 9F LOM '61-'63; Loss of hearing; oteasional earaches ‘5h WB-1/2 116, 3 924 14 F Carious teeth Liver 2 om '62;| neg. '64 LOT cm '62 9K 925 82/60 Sys m ar I '63; noa' TTP '59 Kwa) Hosp.; oo sig hx. '54 Bendfh 145.9 ‘Undascended rt testis ‘52 102/60 Gr I sya mn ‘62; no m '64 | Sl. infection; of throat | a 926 13 F 930 8F Night blindness in '63; URT ‘64 Polio, Tpiles in 159; URT and leg pein ‘64 : TL. O 140.6 §0~1/2 120.7 32/60 Sys a grr '59; no m ‘Sh 10 M 937 18 Z | ' 98/56 | Lhg-1/4 163.7 | | [Nom 128/58 | RLQ scar | gko 15M Deafness '62; otorrhesa '61 gus 137 m-if/h 146.5 gL-1/2 147.3 Tines cn | tzu TT No sig. hx. ‘64 tupetigo on | LiT ur 539 $3 122.9 Patch of : 78/58 Gr I sys apical o y URI 164 | i + 9m. Numerous acars 90/50 Gr I sys m '62 Caries + '62 Molluscum | i | RLQ scar, causef | |. Scars | 106/62 T 950 20 F No complaints! 64 198-1/2 155.4 BEST AVAILASLE COPY 122/82 These | | i