PRIVACY ACT MATERIAL REMOVED
GOVERNMENT OF THE MARSHALL ISLANDS
Majuro, Marshall Islands
Special Health Survey
IDName
:
Sex
-
Age
Residence:
1954-1960
1960-1966
1966-1972
1972-
Uli /Ailuk
Short description of symptoms:
Surgery
Tittot DELTOMY
Year
tT
Have you been receiving treatment for any illness for a pericca
over one year?
.
:
has anyone in your family complained of similar symptoms to the
CHicd Lost HAIR
ones you are now experiencing?
307 Point ded af to- fhyndly
surgery?
Signature
Wa) 198
Date
PRIVACY ACT MATERIAL REMOVED