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1s pationt in any way offensive to other (Paasenger ? (omall, appearance, conduct) ° ss ‘Recent heart attack 7 + ‘Recent operation ? ‘Malfunction of te bladder or boweis Other Symptoms. Does patient need intrevenous treaimentinutrtion during fight | 2 Does patient need exygen curing Mt ? Come) Wee. spe: ram otto... See ee ae os al DIRE 4 re ini ae ieeltaa tao ieng ae _ Nerewith declare that this passenger 's =o une : to undertake the above umay by, pond tat ha pensanger'e gen te Ttoningaangement rs tested 0 lows : §) Dogese of amputation: Letra case (teat ae [7 Scorn ‘Serene TZ) oxeter (all sticher comes musi be escorted ) *) Some erangamant needed fs, oxygen, Wich shoul be proved by‘Sittaye A) 'o Give specie! assistance to important: Fees: 10 Oe Beabengers tothe detriment he service other a Sg n" ‘lonely, they are veined only mn Fret Aid and ore ot —— the nessenger concamed renee =

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