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Have you ever been told you have had any of the following
treatments, conditions or diseases?

High blood pressure/hypertension Kidney disease
Angina/chest pain Organ/cell transplant
Heart attack (myocardial infarction) Cancer
Prosthetic heart valve Radiation therapy
Irregular heartbeat (arrhythmia) Chemotherapy
Pacemaker/defibrillator Epilepsy/seizure
Congestive heart failure Stomach/intestinal disorders
Stroke/TIA Arthritis
Emphysema/bronchitis Artificial joint
Asthma Sexually transmitted disease
Diabetes mellitus AIDS/HIV disease
Thyroid disorder Tuberculosis
Autoimmune disorder Psychiatric disorder
Liver disease Eating disorder
Hepatitis, Viral Allergies
Anemia Pregnancy
Bleeding disorder Osteoporosis

 

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