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Poliomyelitis Cancer Malignant tumor. Leukemia. Heart disease Insult Convulsions. Smallpox. Rheumatic fever. Yes No Diabetes. Nerve disorder / Psychosis. Hypertension. Cirrhosis of a liver. Please check if you have or had any of the following diagnoses Tuberculosis. Hepatitis B C D. Bronchial asthma. Arthritis. Physical inability. Gastric/duodenal ulcer. Kidney disease Skin disease. Syphilis. Please list other chronic diseases surgical operations broken bones or serious...

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