| SYMPTOMS IN THIS AREA | YEAR | YEAR | YEAR | YEAR |
| HEAD | ||||
| EYES | ||||
| EARS | ||||
| THROAT | ||||
| NECK / SPINE - CERVICAL | ||||
| SHOULDERS | ||||
| LEFT UPPER ARM | ||||
| LEFT LOWER ARM | ||||
| LEFT HAND | ||||
| RIGHT UPPER ARM | ||||
| RIGHT LOWER ARM | ||||
| RIGHT HAND | ||||
| CHEST | ||||
| RESPIRATORY | ||||
| MID SPINE - THORACIC | ||||
| LOWER SPINE - LUMBAR | ||||
| ABDOMEN | ||||
| LEFT UPPER LEG | ||||
| LEFT LOWER LEG | ||||
| LEFT FOOT | ||||
| RIGHT UPPER LEG | ||||
| RIGHT LOWER LEG | ||||
| RIGHT FOOT | ||||
© Copyright The
Lincolnshire Post-Polio Network 1999. Document preparation:
Chris Salter,
Original Think-tank, Cornwall,
United Kingdom.
Document Reference: <URL:http://www.zynet.co.uk/ott/polio/lincolnshire/linkpin/forms/form1.html>
Created: 31st March 1999. Last modification: 31st March 1999