14. Worked a job which caused you trouble breathing (cough, shortness of breath, wheezing)?
16. Breathing problems because of weather?
17. Heart trouble or take heart medications?
18. Chest pain or pressure, palpitation or pounding heart?
19. High blood pressure, BP medications?
22. Swelling of ankles or feet, varicose vein?
23. Recent change in weight > 10lbs?
24. Liver disease, hepatitis, ulcer, colitis?
25. Urinary tract infection, blood in urine?
26. Kidney stones or disease?
27. Disorder of the bladder, reproductive organs, or prostate?
29. Excessively low blood sugar?
30. Thyroid disorder or goiter?
31. Numbness or pain in your hands? Carpal Tunnel Syndrome?
32. Nerve injury, numbness, weakness, fatigue?
33. Fracture or broken bone?
34. Rheumatism, arthritis, gout, bursitis, swollen or painful joints?
35. Neck, shoulder, or arm pain, injury, or surgery?
36. Knee injury, pain or surgery??
38. Back pain, strain, herniated disc, or surgery?
39. Anemia, blood disorders?
40. Skin trouble, rash or eczema?
42. Hernias? Please Explain
43. Surgeries? Please Explain
44. Injuries? Please Explain
45. Hospitalizations? Please Explain
46. Filed a compensation claim due to work related injury, illness or disease?
47. Your work limited or restricted due to your health?
48. Lost more than 1 day from work due to illness or injury in the past 2 years?
49. Been refused employment or insurance benefits because of your health?
50. A condition which would require a special work assignment?
51. Been advised to have surgery or medical tests by a medical person?
52. Been rejected for duty or discharge from the armed services for medical reasons?