Sexually Transmitted Disease / Consciousness Vomiting MEDICATION HISTORY ALLERGIES Please list allergies / allergies / Strokes / Alzheimer’s disease / Mental Retardation / HIV / dementia / communicable diseases / birth injuries / Psychiatric/Mental Illness / adolescent injuries / shortness of breath / hallucinations / stroke / Leg pain / disorientation / Acquired Immunodeficiency Syndrome / choking him/herself / related disorders / drug abuse / delirium / illness / No Please list diseases / /
MedicalTreatment
Immunization / medication errors / /
Organization
Friend Agency / Stead Family Memory Center / IN ITS / Banner Alzheimer’s Institute / Health Center / Banner Alzheimer’s Institute Stead Family Memory Center / Center of Excellence / MEMORY CENTER / /
Person
William J. Burke / Relationship / Stead Family / YES HEENT / / /
Position
Attorney / care physician / Director / General INFORMATION Has / physician / Representative / Head / /