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76
SCHEDULE OF MEDICAL INSPECTION.
I.—Name
Surname first.
Date of Birth
Address
School
II.—Personal History:
(a) Previous Illnesses of Child (before admission).
Measles Scarlet Fever
Whooping Cough Diphtheria
Chickenpox Other Illnesses
(b) Family Medical History (if exceptional).
General Observations.
Directions to Parent or Teacher.