Bureau of Health and Sanitation

Front:
Physicians' Request for Supplies Report Cards Release Cards SPOSIV Department of Public Safety P. O. Box 593 Bureau of Health and Sanitation Harrisburg, Pa.

Back:
DISEASES TO BE REPORTED Actinomycosis Anterior Poliomyelitis Anthrax Bubonic Plague Cerebrospinal Meningitis Chickenpox Diphtheria Epidemic Dysentery Erysipelas German Measles Glanders Impetigo Leprosy Malarial Fever Measles Mumps Ophthalmia Pellagra Pneumonia (True) Puerperal Fever Rabies Relapsing Fever Scabies Scarlet Fever Smallpox Tetanus Trachoma Trichiniasis Tuberculosis-all forms Typhoid Fever Typhus Fever Uncinariasis Whooping Cough FORM 50 BUREAU OF HEALTH AND SANITATION Department of Public Safety City of Harrisburg, Pa. Report of Communicable Disease of One or More Cases in Same Family This Report must be made within Twenty-Four Hours to the Health Department by a Physician. Patient Occupation Age Disease Name of Householder Occupation of Householder No. of School Children No. of Persons in Family. Name and Address of Physician Sex. Date 19 School Nativity Color. Date of Onset. 658 M. D.