COMPRESION DEL ESTUDIO, Tesis de Compresión de Datos

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OIHO “IONVIBAZIO “SIJIW Chronia or frequent colds Tumor, growth, cyst, cancer A 3 Severa tooth or gum trouble 38 Rupture/hernia Y Sinusitis MA y | | Piles or rectal disenso ) Hay Fever Vf | | Frequent or paintul uriastion y . Head Injury | | Bed wetting sinco age 12 y + Skin disesses Kidney stone or blood In urine HA Gh A , Thyrcid trouble Y | | Sugar or albumin in urine Ev4 Tuberculosis NV | vD—Syphllis, gonorrhes, etc. ll Asthma Y |_ | Recent gala or loss of welght MA YA Tshortnazs of bresth Y AZ | | próritis, Pheumatizm, or Bart A Pain or pressure In chest % [7 | Bone, Joint or other daformity AV Chronic cough | | Laméness Y | Paipitation or pounding hoart | | //, — |Lossot finger or tos E Y, /J Heart trouble YA | Puintul oe ““tack'* shoulder or sibow Y High or low blood pressure Y L Recurrent back paln Y 16. len bean treated for a mental ¿ / and give deta). pa » AS z : 6. HAVE YOU EVER EXPERIENCED AN UNUSUAL REACFION TO ANY DENTAL ANESTHETIC? 7. DO YOU HAVE HIGH OR LOW BLOOD PRESSURE? de 9. ARE YOU THIRSTY MICH OP THE TIME? 10, DO YOUR AII.ES SWELL? M. DO YOU COUGH BLOOD? 212. DO YOU HAVE PITS OR CONVULSIONS? 13. DO YOU HAVE ANY BLOOD DISCRDER SUCH AS ANEMIA? 14, DO YOU GET TIRED EASILY? 15. DO YOU HAVE ASTHMA, HAY PEVER, OR ANY SINUS CONDITION? 16. AREX0U EVER SHORT OP BREATH OM MILD EXERTIONZ 17. PEWIES ONLY . ARE YOU PREGNANT? DATE LD ficar2 2 SIGNATURE DO YOU BLEED POR A LONG TIME WHEN X0U CUL YOURSELEZ