REGULATIONS AFFECTING SEAMEN

29

9. Treatment, give full details. ........ —————— ———— dS Yt y= SA ———————

10. Final disposition of patient....

11. If sent to Hospital, state where, when admitted, and at whose TDPRI icin os RAHA
12. Probable period of disability ......coccveceeeen .. _.. . mn mmenmceecemceesmesem
13. Had intoxication or venereal diseases anything to do with illness? Tf so, give details... ......._._._._____._.

14. If iil before embarkation, by whom treated... .._
0) Where. omens (BY HOW 100 ooo
15. Give statement, if any, bv sick PETE civic sswmmssm iS SHEA rm mrp SA rm eves ee Em
16. Similar previous illness if any: (a) When .........._._.. e eemmbmemmmcsmmmees tt eiemeemeaenaeeams
B®) Where. oem (0) Detail

17. Remarks ...._.._____..

NAMES OF PERSONS WHO KNEW OF ILLNESS
AND TREATMENT ARFORDED

ADDRREERRER

 Bienatare of Mestan TT iimaties of Ba Menem eon aaa eae

repress eter ere
105676°—28————-3