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Urine.
Name
Address
Age________Occupation S M W
Chemical
Sp. [?] Color
Albumen Reaction
Sugar. Acetone
Indican. Quantity
Blood Pressure Systolic Diastolic
Microscopical
Blood
[Casts.?]
Remarks.
Blood.
Date.
Name
Age Pulse Temp Hour
Hemoglobin
R.B.C. W.B.C.
Polynuclears
Lymphocytes
Eosinophilos
Remarks
Wasserman
Widal.
Malarial Plas.
Remarks.