Nowab brat Brintwnnro sa GRinne ne, Sammy Ano KASHMIR MERA PAGER: CESSES “A” we HE”) ‘Have you ever had any of the following diseases? (Each item must be answered “Yes” or “No”) BS YR Typhusfever No Des i= #H]_—Bacillary dysentery EINo ASJUIRBERE Poliomyelitis €INo ClYes —#HSEAFIHIN] Brucellosis a 1 — Diphtheria No Dyes WRHEYENFA Viral hepatitis M2 4 PH Scarlet fever ONv OYes P= FEE — Puerperal streptococcus infection I #4 fk Relapsing fever No CYes OR OR EIN Des BRAT GE ‘Typhoid and paratyphoid fever No DYes AFHEMEAERABLE Epidemic cerebrospinal meningitis ZINo ClYes FES BA PAVERS Ae timin: (ASU HATE “AR” we HE”) Do you have any of te Following diseases or disorders endangering the publie order and security? (Each item must be answered “Yes” or “No”) DT ‘Toxicomania-~ BLO. HEL, Mental confusion--++--~--4¥-0. HiW#% Psychosis: BREEX! Manic paychosi ALA Paranoid psychosis 4)3¢4) — Hallucinator a SEG NOK om Height | FO cm | Weight 7} 3 BAT PEON Development Nowra Nourishment OY mad oy et ZO Vision 4in_6/C _ man Colour sense NOwmotAR (ibe ea 21H) Normal Chest X-ray exam (attached chest X-ray report) Ree (eae. Hiv Hess GLE AE) _ye Laboratory exam vORL Bes (aitached test report of AIDS, Syphilis etc) AIL AT FP BEAE ROME ANIE TEAS SEB BOT: None of the following diseases of disorders found during the present examination. ef, Cholera HEI Venereal Disease Seiya Yellow fever ASHE Lung tuberculosis RYE —-—~Plague ‘tue AIDS JR Leprosy AMPHIAT — Psychosis a |x i [coog