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Dental braces / Dental equipment / Orthodontics / Cystic fibrosis / Hearing impairment / Dental caries / Pharmaceutical drug / Cerebral palsy / Anemia / Health / Medicine / Congenital disorders


Form: HPE-h12[removed]School Entrance Health Information Form RCE
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Document Date: 2011-05-30 11:22:32

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File Size: 186,56 KB

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Facility

EMOTIONAL Toilet / /

IndustryTerm

food / /

MedicalCondition

understandable Stutters/stammers Lisps Yes____ Yes____ Yes____ No____ No____ No____ DENTAL Cavities Cleft lip / Lacerations / cuts / Abdominal pain / CHRONIC ILLNESSES / Yes____ No____ Spina bifida / No____ No____ Allergies / Drug allergies / tetanus / Cancer / Heart Disease / Scoliosis / Poisoning / Yes____ No____ Hernia / /

MedicalTreatment

Appendectomy / /

NaturalFeature

Serious falls / /

Position

Hives Scabies Body lice Head / /

ProvinceOrState

Missouri / /

SocialTag