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MESOAMERICA TOUR STUDENT HEALTH FORM MEDICAL HISTORY Legal Name First Middle Last Personal Medical History Your Health Problems Y N Acrophobia Diabetes / Hypoglycemia Dementia Menstrual problems severe Allergies Eating disorder Obsessive-Compulsive Anxiety/Panic Attacks Heat reactions PTSD Asthma Hearing loss Reactions/allergies to Drugs Back Problems Heart Problems Schizophrenia Claustrophobia Hernia Seizures Colitis High Blood Pressure Stomach Trouble / Ulcers Depression Hives or Rashes...
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