Schedules used by Local Boards of Health
Health Department, City of Haverhill, Mass
Wad
PHYSICAL RECORD.
NAME
Board of ealtb
....
taecrbill, mas.
Nnd of Puher
ory of Ms
o C in Fmry
Tgpboid fever Case Card. Pear
Venated
a
a 4
Cnd M
Case Ni
Kopseted
he
Date of ghysicin's Srat visit
Dane of patieet's poing to bed
Name of patient
years
age
Kt
CgT
Character
residence, private hou, barding boase, hotel, fat, stoee, baseaet, len other
Aay sewcomers in hossehold within three mostha
When
Where
We scomrrs sccisted with tynhoid ootriemts
wcs bee
NDNGS
privy in yan
vams
ly mal lol
resin
a aeighborbood
Trevices cases of typboid in hosse
from.
Occupaticn
alace
tor
place o
P
.
ree Sum
Food, within se days neior to ilteas: where takra
MN, how usel
Source of mik supply, incledng oream and skim mil
Uscookod frait and egstables
Raw sholl fisb3
FRST VISIT
OPHTHALMIA NEONATORUM
www.
Previoas attack of typoid
Dae of Binh
Na of Baly
from Haverha
within
ays pre
o anses
Date of Fine Syw
Aress,
Dee of Noricales
Name ot hyalcis
Association with patients n febrile stage
with sasnected cases
Association with persens peesioaly had typhoid within six moschs.
d be whom
ber Adie
antact wich patiests in febrile stage
N. of taleenast
wst Toestm
Tratment of stools and urine of patients
ober arecastions
RMARKS
Tty
owE
