124
NO.,
AGE,
WEIGHT
POUNDS
HEICHT
PAST
SEX
HISTORY
INJURIES
CENTIMETERS
BLOOD PRESSURE
HEART
&
LUNGS
ABDOMEN
EENT
Gu or Gyn
SKIN
1055
1f
1056
8-3/4#
1M
LOST
15¢
No m
8-1/2 #|
Nom
nostrils; no hx.
of sig. '64
30-1/4
96.1
78/58
Gr I apical sys
m
Polio (7) date?;
no sig. history
aside fran leg
pains '6h
25-1/4
85.2
Gr I apical sys
tm
1F
1058
1M
1503
6M
1504
2M
I00 6¢ 0
Sores on
Scars