Possible Long-Term Health Effects of Short-Term Exposure To Chemical Agents, Volume 3 Final Report: Current Health Status of Test Subjects (1985) / Chapter Skim
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Appendix E The Questionnaire and Related Material (Exhibits A, B, C, D, and E)
Appendix E The Questionnaire and Related Material (Exhibits A, B, C, D, and E)
Pages 89-100
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From page 89... ...
Sincerely, ~~' Robert J Keehn Study Supervisor RJK/mb Enclosure —89— Thr National Research Council ~ the principal operahng agency of the Nahona!
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From page 90... ...
since separation from active military senace (record in order started) : Date of separation Cal m Month Year .
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From page 91... ...
Please give the following information for children you fathered who were alive at birth (answer starting with the fist child loom)
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From page 92... ...
(please record your daily consumption for each form of tobacco) : Cigarettes, number of packs daily Cigars, number daily A
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From page 93... ...
a. During the past five years have you had medical care for any disease or illness?
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From page 94... ...
If you need additional space to complete your reply to any question, or wish to make any additional comments, please attach extra pages as needed. (Please indicate question number of responses being continued)
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From page 95... ...
Sincerely, At' Robert J Keehn Study Supervisor —95— E~IlBIT B OFFICE LOCATION JOSEPH HENRY BUltDING 2lST STREET AND PENNSYLVANIA AVENUE, N W
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From page 97... ...
C 20418 MEDICAL FOLLOW-UP AGENCY This third request for information concerning your health has been sent by certified mail so that we will Snow that it has been delivered to yap and that our lack of a reply to the earlier requests was not due to a wrong addre ss.
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From page 99... ...
D RESULT CODES TcmPorar~ Codes 1 ~ Ring, No Answer 2 ~ Busy Signal 3 = Unable to toca~ce/Coctact Respoodcat 4 ~ Respondent Not Available 5 ~ Appointment Made 6 = Breakoff/~rtial.Dats 7 s Language Barrier 8 ~ Other (explain in notes)
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From page 100... ...
2. Do you remember receiving a health survey questionnaire in the mail recently from the National Research Council?
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