Texas Register, Volume 7, Number 89, Pages 4125-4234, December 3, 1982 Page: 4,142
4125-4234 p. ; 28 cm.View a full description of this periodical.
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Texas
RegisterREPORT OF MALIGNANT NEOPLASMS
STATEWIDE CANCER REGISTRY PROGRAM1. Registry Number
2. Hospital Chart Number
3. Hospital/Laboratory Na
Ci
4. Name5. Address
LAST
FIRST
MIDDLE
STREET
CITY
Social Security Number
7.Dt f irh___STATE
7. - Date of. Birth / /
S MO DAY YEAR
8. Race/Ethnicity (Check One)
Caucasian, not otherwise specified
Caucasian, Spanish surname or origin
Black
American Indian
Chinese
9. Sex (Check One)
Male
Female
10. Permanent Contact
Name
AddressSTREET
ZIP
COUNTY
Japanese
Filipino
Hawaiian
Other (Specify)
UnknownRelationship
CITY
STATE
ZIP
Home Phone
11. Date of Initial Diagnosis / /
MO DAY YEAR12.
13.
14.
15.
16.
17.Final Diagnos
Primary Site
Histologic Ty
Basis of Diab
Date of Death
Attending Phyis
-r . ICD Code _ '
rpe __ ICD Morphology ,Code
Inos I s,sician
11/4/82
7 TexReg 4142 December 3, 1982
MAIDEN
III I I [ II I II II I1 II C I III I I III IIII
_ _____ _ ___
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Texas. Secretary of State. Texas Register, Volume 7, Number 89, Pages 4125-4234, December 3, 1982, periodical, December 3, 1982; Austin, Texas. (https://texashistory.unt.edu/ark:/67531/metapth244852/m1/18/: accessed July 17, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.