Previous Illness

Did you ever have: yes/no when? Did you ever have: yes/no when?

Blood Transfusion n
High Blood Pressure n

Measles y childhood Venereal Disease

Mumps y childhood Kidney Disease n

Chickenpox y childhood Epilepsy n

Scarlet Fever scarletina? childhood? Anemia y 3 months ago

Rheumatic Fever n
Major Surgeries tonsils age 8

Diabetes n
Other HIV+^* 6 years ago

Heart Disease n
Other Pneumonia (PCP) 3 years ago

^*Referral history from Dr. Awad states that the CD4+ cell count was 30/ul last month.

Did you ever have:	yes/no	when?	Did you ever have:	yes/no	when?
Blood Transfusion	n		High Blood Pressure	n
Measles	y	childhood	Venereal Disease
Mumps	y	childhood	Kidney Disease	n
Chickenpox	y	childhood	Epilepsy	n
Scarlet Fever	scarletina?	childhood?	Anemia	y	3 months ago
Rheumatic Fever	n		Major Surgeries	tonsils	age 8
Diabetes	n		Other	HIV+^*	6 years ago
Heart Disease	n		Other	Pneumonia (PCP)	3 years ago