[Report of the Medical Officer of Health for East Ham] page 67

East Ham 1910

[Report of the Medical Officer of Health for East Ham]

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Name									Date of Birth
Surname first). Address									Removed to
Removed to									Do
School															Date of leaving School
Date of admission															Date of leaving School
		Scarlet Fever.		Diphtheria.		. Measles. \|		Whooping Cough.		Chicken Pox.		Mumps.		Rheumatic Fever.
Date of Illnesses
Year		19	19		19		19		19	19......	19......		19......		19......		19......
Actual at tendances
Possible attendances													.
Family History (if exceptional)							Directions to Parents or Teachers					General Observations.
Occupation	F.					I
Occupation	M					I
* Total Number of	Rooms	Families	Adults Children			II
Consumption on Fathers side ?						III
Do. on Mother's side ?						III
Work before or after School.		Nature				IV
Work before or after School.		Duration				IV