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>Email 4
>
>SECTION D:  MAJOR CHILDHOOD ILLNESSES, ACCIDENTS AND CONDITIONS
>TO ANSWER SECTION D:  CHECK AREAS THAT APPLY TO YOU.  IF AT ANY TIME YOU
>REMEMBER MEDICATIONS OR OVER THE COUNTER DRUGS USED FOR YOUR CARE, LIST
>THEM BESIDE THE CONDITION.  DO NOT LIST CURRENT PD MEDS HERE.
>
>ADD
>
>ADHD
>
>Allergies
>
>Anemia
>
>Anorexic
>
>Anxiety
>
>Asbestos
>
>Asthma
>
>Blood Transfusions
>
>Bouts of High Fever
>
>Bulimia
>
>Carbon Monoxide Poisoning
>
>Chicken Pox
>
>Chronic Constipation
>
>Depression:
>
>Diphtheria
>
>Ear Infections
>
>Ear Surgery
>
>Excessive Diarrhea
>
>Excessive Vomiting
>
>Fluoride
>
>German Measles
>
>Lead Paint
>
>Malnutrition
>
>Measles
>
>Mercury Fillings
>
>Mononucleosis
>
>Over Achiever
>
>Persistent Nasal Drip
>
>Pneumonia
>
>Polio
>
>Recurring Abdominal Pain
>
>Recurring Headaches
>
>RLS
>
>Scarlet Fever
>
>Sore Throat
>
>Speech Problems
>
>Strep Throat
>
>Stress
>
>Swollen Glands
>
>Tonsillectomy
>
>Tonsillitis
>
>Typhoid Fever
>
>Underachiever
>
>Urinary Tract Infections
>
>Whooping Cough
>
>Exposure to Formaldehyde
>
>
>
>Stress Headaches:              Often
>                               Periodically
>                               Other: ___________________
>
>Injuries to the Spinal Column: Bruises
>                                               Fractures
>                                               Other: __________________________
>
>Accident(s):   How many? _____ Type(s) of Injury:Head
>                                                                       Spine
>                                                                       Legs
>                                                                       Arms
>                                                                       Other: ________________
>
>Head Trauma(s):        How many? _____ Type(s):        Mild
>                                                               Severe
>                                                               Other: ____________
>
>State(s) of Unconsciousness:   How many times? _____   How long? _____
>
>Surgeries:     How many? _____ Types: _______________________________
>
>Exposure to:   Drugs
>                       Alcohol
>                       Physical Abuse
>                       Other: ____________________
>
>Genetic Disorder(s):           Name it (them): ____________________________
>
>If given Antidepressants as a child:   List medications: ________________
>
>
>
>

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