Document g2gyxYneebG0LQOxbnqX2ZXgV

1-.1 Have you ever beer, told by a doctor that you had any of the following conditions? Carriio-Vas cular 01. Heart murmur 02. Angina . 03. Heart Attack 04. Any other heart condition for which you are under the care of a doctor? (specify) 05. High blood pressure 05. Claudication Pulmonary 07. ' Pneumonia OS. Pleurisy 09. Asthma 10. Eronchitis 11. Emphysema 12. Bronchiectasis 13. Pulmonary tuberculosis 14. Silicosis 15. Asbestosis 16,, Other Pulmonary (specify) Gastrointestinal 17. Gastric ulcer - told by M.D. 16. " " - UGIS 19. " " . - Hemorrhage 20. Duodenal ulcer - told by M.D. 21. ' " " - UGIS 22. " " - Hemorrhage 23. Bleeding from ulcer 24. Other G1 bleeding 25. Hiatus hernia 26. Hepatitis 27. Jaundice 2S. Gall bladder disease 29. Liver disease 30. Enlarged liver 31. Cirrhosis - alcoholic 32. " - Other 33. Ulcerative colitis 34. Diverticulitis 35. Other C-I (specify) C-eni touri nary 36. Nephritis 37. Kidney disease (indicate type) 3S. Urinary infection 39. Kidney stones 40. Prostate enlargement '41. Blood in urine (not caused by above) 42.. Protein in urine (not caused by above conditions) 43. Other genitourinary Skin 44. Psoriasis 45. Eczema 46. Other skin (specify) Blood 47. Acute Anemia 48. Chronic Anemia " 49. Low white blood count 50. Problems with blood clotting or bleeding 51. Sickle cell 52. Thalessemie 53. Other Blood (specify) Eye 54. Require glasses 55. Glaucoma 56. Cataracts 57. Weak or lazy eye 58. Optic neuritis 59. Other Eye (specify) Ear, Nose and Throat, 60. Chronic Sinusitis 61. Impaired hearing 62. Nasal allergies Reproduced from fifgfg best available copy,