Document e8vK471ZKOqQqJGNqJEnaxv9

Employe Name (continued)__________________________33. X-Ray Identification Number---------------By Whom Taken?;___________________________________ 35. Date Taken X-Ray Findings and Remarks:______________________________________________________ Silicosis ?________ _______________ Tuberculosis?___________________ Recommendations:______________ Special Urine Examinations: (When Indicated or Requested) a. Lead (Milligrams per liter)____ b. Mercury (Milligrams per liter).. c. Urine Sulfate (Benzol) (Jo)....... d. Other (Specify).............. ............ Wasserman or Kahn__________ (When Indicated or Requested) Hood Count: (When Indicated or Requested) a. Red Cells (No.)............... ........... t>. White Cells (No.).;___________ c. Hemoglobin (Jo)_____________ d. Differential Count: Neutrophils (Jo)_____ ______ Basophils (Jo)_________ ___ _ Eosinophils (Jo).................... . Large Lymphocytes (Jo)___ Small Lymphocytes (Jo)____ e. Basophilic Aggregation (Jo)___ f. Stipple Count (Jo).............. ....... g. Reticulocytes (Jo)....................... h. Other Findings.......................... Sedimentation................................... (When Indicated or Requested) Blood Analysis: (When Indicated or Requested) a. Lead (Milligrams per liter)....... b. Mercury (Milligrams per liter).. c. Other (Specify).......................... Comments and Recommendations: Signed:M.D. Address------------------------------------------ ;.................................... Date_______ Date____ Date.. VPD-189-0002449 Signed- Address Date......