By Robert W. Blum (Eds.)

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2. Sex: Female 3. Address 4. Name you w o u l d like to be called 5. Home phone 6. When were you born_ month 7. If it is necessary to contact you about an appointment or tests, may we: Call you? yes no (if yes, no message will be left unless you wish us t o : leave message) Write you? yes day year no 8. In case of an emergency, w h o m should we call? Name 9. Is this clinic the main place you go for health care? Phone yes no 10. What other places do you go for health care or counselling? This is very important because it may be necessary to check records at other places to find out about diseases you have had, medicines or tests that have been done in the past.

It is not only the right but the duty of parents to pro­ vide for the proper care and nursing of their very young children and, if need be, to provide for surgi­ cal operations upon them or hospital treatment or both. In these matters, the wishes of young children are not consulted nor their consent asked when they are old enough to give expression (Weston, 1921, p. 60). THE PARENTAL ROLE Deeply rooted within the American legal tradi­ tion is the notion that children should be con­ trolled by their parents.

Had any serious injuries (concussions, broken bones, etc)? What kind? yes no no When? When? no yes When? 50. As you were growing up, you probably had some childhood diseases or possibly other problems. Please check those that you remember having had (or now have). measles vaginal or pelvic infections mumps dizzy spells chicken pox breathing problems German measles (rubella) bladder or kidney problems (urine infections) rheumatic fever heart problems or high blood pressure diabetes stomach problems.

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