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MASTER SHEET AND GENERAL HISTORY GRAHAM CLINIC ADMISSION DATE DR AGE DATE OF BIRTH SEX. TRUMAN, MR. HARRY S. BIRTHPLACE 8May , 1884 40Pm M. S. W. D SEP (CIRCLE ONE) OCCUPATION The President of The U.S. LOCAL ADDRESS PHONE NO REFERRING DR LETTER TO DR DATE ADDRESS OF REFERRING DR LETTER TO DR DATE LETTER TO DR DATE RESPONSIBLE PARTY. OCCUPATION OF R. P ADDRESS OF RESPONSIBLE PARTY CITY STATE PATIENT REQUESTS LETTER TO ADDRESS DISCHARGE PHYSICIAN'S DIAGNOSIS-SURGERY-DISPOSITION & CONDITION ON DISCHARGE-SPECIA THERAPY STUDY CODE DATE SIGNATURE POST OPERATIVE COMPLICATIONS NO. (DIAGNOSTIC ENTRIES USED FOR INDEXING. DO NOT ENTER SYMPTOMS IN ADDITION TO DIAGNOSIS: OR NOTES OF PAST HISTORY) NARA I. L.C.R.

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