M123 Medical History


B22 Iím short of breath.

M47 I get out of breath after the slightest exertion.

B23 I start panting after a short walk.

C46 When I am under pressure C82 I get a funny feeling in my chest.


M17 I have arthritis in my hip.

B5 I have a lot of pain


M93 I am having treatment for: X31 rheumatism


M12 I suffer from asthma.

M13 I use an inhaler.


M78 when I was a student B70 I had a skiing accident.

B71 I broke my leg.


B89 I suffer from migraine.

B76 I was involved in a car accident. O68 last year


M50 I have several allergies.

M51 I am allergic to cheese.

M52 I have a milk allergy.

M121 I am allergic to aspirin.


M122 Personal details


N1 My name:Ichiro Tanaka

N2 My nationality:Japanese

My age:68

N4 My present address:Hotel Rus, Moscow

N5 My email address:ichiro.tanaka@ymobile.ne.jp

N7 My mobile number:+81 090 3007 2142

N19 Date I depart:26/11/2018