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Ja：  Hiwise.Jrs: Cia P. Thicvtton<\_\_0---\_

l. History obtsired at initial exziration ard during the course of treatment.

2. His personal knovlcdge of the decedent, particularly his personality pattern prior to the acute illnass.

3. Cozplaints and findings (subjective as tell as objoctive), including laboratory excinations.

h. Clinical bcurse of condition during the period of observation and treataent.

5. Diegnoses.

6. If this is an acute psychosis, epinion as to relaticnship, if ary, to the work in which he wes enaoged. Te should like a full ard corplnte discussish of the situaticn, with reesoned explanation for any opinion crressed. If practiceble, citations frcn ncdical literatutc in support of exprcsced opirion rould be appreciated.

7. Any other infomation considered pertirent to the qucstion of relaticnrkip betreen the work and the illness responsible for the death.

8. opitien ar to meufal csmupeyener iu courle wifL VA