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                                      2.0 Health Problems and Symptoms  ( check all the ones the person has....use ID #)

 2.1      ergonomic
                ____  2.1.1    back pain
                ____  2.1.2    wrist pain
                ____  2.1.3    hand pain
                ____  2.1.4    shoulder pain
                ____  2.1.5    knee pain
                ____  2.1.6    neck pain
                ____  2.1.7    other musculoskeletal problems

 2.2      respiratory
                ____  2.2.1    runny/stuffy nose
                ____  2.2.2    itchy or watery eyes
                ____  2.2.3    coughing
                ____  2.2.4    difficulty breathing
                ____  2.2.5    asthma
                ____  2.2.6    chronic headaches

 2.3      diseases
                ____  2.3.1    cancer               What kind? ________________
                ____  2.3.2    rabies
                ____  2.3.3    worms                What kind? ________________
                ____  2.3.4    staph infection

 2.4      skin
                ____  2.4.1     red, dry, cracked or painful skin  Where?______________
                ____  2.4.2     ringworm or fungal infection        Where? ______________
                ____  2.4.3     itching of skin                             Where? ______________
                ____  2.4.4     rash                                            Where? ______________
                ____  2.4.5     hives                                           Where? ______________

 2.5      pesticide exposure symptoms
                ____  2.5.1     headache
                ____  2.5.2     convulsions
                ____  2.5.3     tingling extremities
                ____  2.5.4     dizziness
                ____  2.5.5     muscle weakness
                ____  2.5.6     joint swelling or pain
                ____  2.5.7     incoordination
                ____  2.5.8     muscle twitching
                ____  2.5.9     tremor
                ____  2.5.10   nausea
                ____  2.5.11   abdominal cramps
                ____  2.5.12   diarrhea
                ____  2.5.13   sweating
                ____  2.5.14   mental confusion
                ____  2.5.15   phlegm
                ____  2.5.16   increased saliva
 
 
 
 

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