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