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Birth Yr
Height
M/F
Date
Time
Weight
N
P
C
Pulse
Rate
Blood
pres-
sure
Tem-
pera-
ture
Glu-
cose
Calor-
ies
Exer-
cise
(min.)
L
M
H
Sleep
(min.)
Weight: N = Nude; P = Partial clothing; and C = Clothed Exercise: L = Light; M = Medium; and H = Heavy
History
(most recent listed first)