English Translation

09 4. Data on family history a) Have similar or similar conditions of illness or suffering been observed in the narrower family or other relatives? Pg. F. with whom (name and address and what ailments or illnesses? b) Are there any striking diseases of any other kind in the closer family or any other kinship. The following questions must be completed in the event of notification by the treating physician. In the case of notification of midwifery, they must be supplemented by the official doctor, as far as possible. (a) Medical diagnosis (b) Is there a medical opinion that there is a risk of suffering or healing? (a e d e) Does the life of the child likely to be limited by the condition? Is death expected in the next since? The institution and duration of observation bziw. of treatment? e) Type of treatment ? H Does physical development correspond to the age of the child — to what extent not? (Genane information) g) Does the mental development correspond with the child's age - not infern? (Exact information) h) General behaviour: Mentally dull? Agile? Sick urges? i) Are cramps observed toorden? 1. When first occurred? When and how often repeated? 2. Duration? Tonic or cloning cramps? 3. Which body areas? Adductoral pasm? The doctor is asked to complete the information of the midwife on family history if necessary: 61909 the 194 (underwent by the Hehamme) (lineeftrift des Argets) Further forms are to be requested from the health caregivers.