|
Diabetes
|
YesNo
|
YesNo
|
|
Family History
|
YesNo
If yes, then
MotherFatherBoth
|
YesNo
If yes, then
MotherFatherBoth
|
|
|
|
Hyper Tension
|
YesNo
|
YesNo
|
|
Family History
|
YesNo
If yes, then
MotherFatherBoth
|
YesNo
If yes, then
MotherFatherBoth
|
|
|
|
Cardiac Disease
|
YesNo
|
YesNo
|
|
Family History
|
YesNo
If yes, then
MotherFatherBoth
|
YesNo
If yes, then
MotherFatherBoth
|
|
|
|
Asthma
|
YesNo
|
YesNo
|
|
Family History
|
YesNo
If yes, then
MotherFatherBoth
|
YesNo
If yes, then
MotherFatherBoth
|
|
|
|
Epilepsy
|
YesNo
|
YesNo
|
|
Family History
|
YesNo
If yes, then
MotherFatherBoth
|
YesNo
If yes, then
MotherFatherBoth
|
|
|
|
Any drug Allergies
|
YesNo
|
YesNo
|
|
Please specify
|
|
|
|
|
