Cx
PRIVACY ACT MATERIAL REMOVED
_ GOVERNMENT OF THE MARSEALL ISLANDS
Majuro, Maxrsnali. Ysiands
Speciai Health Surver
Nene
.
Sex F-
|
Age /
nesidence:
igsc-1960- A/KIEB Aro
1960-1566¥,
1966-1972.ey
Srore Gescription of SYD+
/
flit dpeWE LUAKESE , Fen r oj
DArCary
Moe
es
—_
ARK
mI
.
.
“ost
f
wy
Cvenl er bO
Year
¢
mnaVeG you been receiving treatment for any illness for 4 perios
over one year?
Ye
“kas anvone in your fdmily compiained of similar symptoms to tne
Cucs you are now experiencing?
)
Surgery?
Lever
DateIA, (2 T7F
5011825
PRIVACY ACT MATERIAL REMOVED