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Subject No. _________ Study No. Int. ID No. 568 NORTHWESTERN UNIVERSITY KRUMMRICH STUDY Medical History Questionnaire prepared by The University of Illinois Survey Research Laboratory November, 1985 (PRETEST) We wish to thank the National Institute for Occupational Safety and Health and its subcontractors for their valuable assistance and use of their previously developed survey instruments. DSW 476038.1221 STLCOPCB4043372