Previous Illnesses

Did you ever have:	yes/no	when?	Did you ever have:	yes/no	when?
Blood Transfusion	n		High Blood Pressure	n
Measles	y	5 years old	Venereal Disease	n
Mumps	y	7 years old	Kidney Disease	n
Chickenpox	y	10 years old	Epilepsy	n
Scarlet Fever	n		Anemia	n
Rheumatic Fever	n		Major Surgeries	none
Diabetes	n		Other	arthritis
Heart Disease	n		Other	3 months ago a cough and dull achy chest pain*.

* Records of this illness available on request