UNIVERSITY OF KANSAS
HEALTH SERVICE

ue WATKINS ME RIAL HOSPITAL |
Name ¥ LM. /, os
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pie a ee LL i fees po
Confined to Hospital.....: Via op ee of fy mee

Known to be ill at home ce

This is not an exeuse but a statement of illness.
op Les signed_by a physician.

(Melee Lee A 2. M.D.

 
 

 

  

Date Issued.......