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n
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/CaboText:TX_43 <>BDC
BT
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(Crawl)Tj
ET
EMC
/ BMC
391.5 643.5 m
391.5 621.0028 l
422.9972 621.0028 l
422.9972 643.5 l
391.5 643.5 l
n
391.5 621.0028 m
423 621.0028 l
422.9972 621.0028 m
422.9972 643.5014 l
422.9972 643.5 m
391.4972 643.5 l
S
EMC
/ BMC
423 643.5 m
423 621.0028 l
508.4972 621.0028 l
508.4972 643.5 l
423 643.5 l
n
423 621.0028 m
508.5 621.0028 l
508.4972 621.0028 m
508.4972 643.5014 l
508.4972 643.5 m
422.9972 643.5 l
S
EMC
/ BMC
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508.5 621.0028 l
589.4972 621.0028 l
589.4972 643.5 l
508.5 643.5 l
n
508.5 621.0028 m
589.5 621.0028 l
589.4972 621.0028 m
589.4972 643.5014 l
589.4972 643.5 m
508.4972 643.5 l
S
EMC
/CaboText:TX_46 <>BDC
BT
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(Explain )Tj
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(you )Tj
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ET
EMC
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22.5 621 m
22.5 576.0028 l
589.4972 576.0028 l
589.4972 621 l
22.5 621 l
n
22.5 621 m
22.5 576 l
22.5 576.0028 m
589.5 576.0028 l
589.4972 576.0028 m
589.4972 621.0028 l
S
EMC
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BT
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(Check )Tj
(heaviest )Tj
(weight )Tj
(lifted)Tj
ET
EMC
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22.5 576 m
22.5 553.5028 l
589.4972 553.5028 l
589.4972 576 l
22.5 576 l
n
22.5 575.9986 m
22.5 553.5 l
22.5 553.5028 m
589.5 553.5028 l
589.4972 553.5028 m
589.4972 576.0014 l
S
EMC
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BT
/TT0 1 Tf
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(Less )Tj
(than )Tj
(10 )Tj
(lbs)Tj
ET
EMC
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BT
/TT0 1 Tf
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(10 )Tj
(lbs)Tj
ET
EMC
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BT
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(20 )Tj
(lbs)Tj
ET
EMC
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BT
/TT0 1 Tf
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(50 )Tj
(lbs)Tj
ET
EMC
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BT
/TT0 1 Tf
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(100 )Tj
(lbs. )Tj
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ET
EMC
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BT
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(Other )Tj
(_____________)Tj
ET
EMC
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BT
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(Less )Tj
(than )Tj
(10 )Tj
(lbs)Tj
ET
EMC
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BT
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(Check )Tj
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EMC
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BT
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(10 )Tj
(lbs)Tj
ET
EMC
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BT
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(25 )Tj
(lbs)Tj
ET
EMC
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BT
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8 0 0 8 309.5086 533.2807 Tm
(50 )Tj
(lbs )Tj
(or )Tj
(more)Tj
ET
EMC
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BT
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(Other )Tj
(_____________)Tj
ET
EMC
/ BMC
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22.5 531.0028 l
589.4972 531.0028 l
589.4972 553.5 l
22.5 553.5 l
n
22.5 553.4986 m
22.5 531 l
22.5 531.0028 m
589.5 531.0028 l
589.4972 531.0028 m
589.4972 553.5014 l
S
EMC
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BT
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(Section )Tj
3.8895 0 Td
(4 )Tj
(- )Tj
(Information )Tj
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(About )Tj
3.1475 0 Td
(Your )Tj
2.4815 0 Td
(Medical )Tj
(Records)Tj
ET
EMC
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BT
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(doctor/hospital/clinic )Tj
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(or )Tj
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(else )Tj
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(injuries, )Tj
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(or )Tj
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(that )Tj
(limit )Tj
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(your )Tj
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EMC
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S
/CaboText:Seen_by_doctor_for_illness <>BDC
BT
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(Yes)Tj
ET
EMC
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BT
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(No)Tj
ET
EMC
/ BMC
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310.5 490.5028 l
589.4972 490.5028 l
589.4972 513 l
310.5 513 l
n
310.5 490.5028 m
589.5 490.5028 l
589.4972 490.5028 m
589.4972 513.0014 l
589.4972 513 m
310.4972 513 l
S
EMC
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BT
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(If )Tj
(you )Tj
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(answered )Tj
("No" )Tj
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(both )Tj
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(of )Tj
(the )Tj
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(questions )Tj
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(above, )Tj
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(Section )Tj
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ET
EMC
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(List )Tj
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(Doctor/HMO/Therapist )Tj
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EMC
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(Name )Tj
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(of )Tj
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ET
EMC
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S
/CaboText:TX_52 <>BDC
BT
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(Date )Tj
(of )Tj
(First )Tj
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(Visit)Tj
ET
EMC
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310.5 418.5028 l
400.4972 418.5028 l
400.4972 441 l
310.5 441 l
n
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400.5 418.5028 l
400.4972 418.5028 m
400.4972 441.0014 l
400.4972 441 m
310.4972 441 l
S
EMC
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BT
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(Date )Tj
(of )Tj
(Last )Tj
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(Visit)Tj
ET
EMC
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400.5 418.5028 l
490.4972 418.5028 l
490.4972 441 l
400.5 441 l
n
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490.5 418.5028 l
490.4972 418.5028 m
490.4972 441.0014 l
490.4972 441 m
400.4972 441 l
S
EMC
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BT
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(Date )Tj
(of )Tj
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(Appointment)Tj
ET
EMC
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490.5 418.5028 l
589.4972 418.5028 l
589.4972 441 l
490.5 441 l
n
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589.5 418.5028 l
589.4972 418.5028 m
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589.4972 441 m
490.4972 441 l
S
EMC
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BT
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(Address)Tj
ET
EMC
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(City)Tj
ET
EMC
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(State)Tj
ET
EMC
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BT
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(Zip )Tj
(Code)Tj
ET
EMC
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22.5 396.0028 l
233.9972 396.0028 l
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S
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S
EMC
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n
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EMC
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(Number)Tj
ET
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EMC
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S
EMC
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(Chart/HMO )Tj
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310.4972 441 l
229.5 441 l
n
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S
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(City)Tj
ET
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22.5 121.5028 l
233.9972 121.5028 l
233.9972 144 l
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EMC
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S
EMC
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(State)Tj
ET
EMC
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234 121.5028 l
364.4972 121.5028 l
364.4972 144 l
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n
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364.5 121.5028 l
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S
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(Zip )Tj
(Code)Tj
ET
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S
EMC
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n
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EMC
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ET
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S
EMC
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n
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S
EMC
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n
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S
EMC
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S
EMC
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(List )Tj
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S
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(Yes)Tj
ET
EMC
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(No)Tj
ET
EMC
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EMC
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(Address)Tj
ET
EMC
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BT
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(City)Tj
ET
EMC
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233.9972 261.0028 l
233.9972 283.5 l
22.5 283.5 l
n
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S
EMC
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(Chart/HMO )Tj
(Number)Tj
ET
EMC
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310.4972 283.5028 l
310.4972 306 l
229.5 306 l
n
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229.4972 306 l
S
EMC
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(Date )Tj
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ET
EMC
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