Name |
|
State |
|
Amount |
|
Health |
|
Type |
|
Year of Birth |
|
|
Male
|
|
Female
|
Occupation title |
|
Work discription |
|
Tobacco use |
|
Driving record |
|
Lifestyle |
|
Cholesterol level |
|
Systolic blood pressure |
|
Diastolic blood pressure |
|
Family history chronic diseases: |
|
Parent / sibling(s) |
|
Prescription use |
|
Thoughts: |
|
|
|
