PRIVACY ACT MATERIAL REMOVED
GOVERNMENT OF THU MARSIiALL ISLANDS
Majuro, Marshall Islands .
Special Health Survey
|
Sex
(
Nai
(22°77)
Residence:
1954-1960
1960-1966
1966-1972
1972-
—
(19a!
fR
-
—
ageVG
JB
blot
. Short description of symptoms:
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Surgery
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Year
{
(47?
nave you been receiving treatment for any illness for a pexics
over
one year?
Eas anyone in your family complained of similar symptoms to the
ones you are now experiencing?
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Signature
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PRIVACYACT MATERIAL REMOVED
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