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Get Health Examination Report Form - HELP University

S SELF Yes No IMMEDIATE FAMILY Yes If Yes please state details No 1. Congenital or Inherited Disorder 2. Allergy 3. Mental Illness 4. Fits, Stroke, Other Neurological Disease 5. Diabetes Mellitus 6. Hypertension 7. Heart or Vascular Disease 8. Asthma 9. Thyroid Disease 10. Kidney Disease 11. Cancer 12. History of Surgery 13. Tuberculosis (TB) 14. HIV / AIDS 15. Hepatitis B 16. Sexually Transmitted Diseases 17. Drug Addiction 18. Other Illnesses Current medication (Long Term) VACCIN.

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