strctians (Specify) 20 Abuse. substance/ physical / emotional 21 NuPlti0n 22 Owe. I COMMENT: Abnormal Findings, by number B. HEALTH HISTORY (Serious Illnesses Intures. explain) 'attach narrative if addition; space nocdcd) C. LABORATORY (as in0Celei3) Hemoglobir/Hcmctocrt Stool1O8 n Tuberculin teal Sckle