Methods for the analysis of human chromosome aberrations / edited by K.E. Buckton, H.J. Evans.

Date:
1973
Catalogue details

Licence: Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0)

Credit: Methods for the analysis of human chromosome aberrations / edited by K.E. Buckton, H.J. Evans. Source: Wellcome Collection.

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    Annex 5 MEDICAL RECORD FORM Name: Place of employment: Sex: Occupation: Date of birth: Date when record taken Medical History Questionnaire If you answer yes please give details, e.g., time and place. 1. Have you ever had a major X-ray investigation, e.g., X-ray of the stomach (barium meal) bowel (barium enema) kidney (intravenous pyelogram) fractured bone ? 2. Have you ever been treated in a radiotherapy department? 3. Have you ever undergone an investigation of the thyroid gland? 4. Have you ever had treatment for tuberculosis? 5. Have you ever received medical treatment by drugs for a period of more than 1 month? 6. Have you ever been employed in the manufacture, processing, or hand ling of chemicals, e.g., rubber, explosives, or insecticides? 7. Have you had an infection, e.g., a cold or influenza, within the last month?