Low Blood pressure Heart Attack Blood Bleeding disorders HIV Anaemia Hepatitis Genetic disorders Haemophilia Other Heart/Blood Conditions or details: Chest Bronchitis Pneumonia Cystic fibrosis Emphysema Chest surgery COPD Other Chest Conditions: Once completed, please return form to Other Stroke Liver disease Epilepsy Diabetes Kidney disease Cancer Reaction to GA Arthritis Any other conditions or concerns we need to be aware of: Reaction to LA Replacement joint Bone disease
Low Blood pressure Heart Attack Blood Bleeding disorders Hepatitis HIV Genetic disorders Anaemia Haemophilia Other Heart/Blood Conditions or details: Chest Bronchitis Emphysema Pneumonia Chest surgery Cystic fibrosis COPD Other Chest Conditions: Other Stroke Diabetes Reaction to GA Reaction to LA Liver disease Kidney disease Arthritis Replacement joint Bone disease Epilepsy Cancer Any other conditions or concerns we need to be aware of: Once completed, please return form to
electronic-mh-form.docx