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OSWEGO.QES
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1994-08-22
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648b
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22 lines
Questionnaire for Church Supper - Oswego
Age:### Sex:<A> Time of Supper(24 hour):####
Ill? <Y> {Onset Date} (MM/DD): <mm/dd> {Onset Time} (24 hour):####
Food History (Mark Y or N):
Baked Ham:<Y>
Spinach:<Y>
Mashed Potatoes:<Y>
Cabbage Salad:<Y>
Jello:<Y>
Rolls:<Y>
Brown Bread:<Y>
Milk:<Y>
Coffee:<Y>
Water:<Y>
Cakes:<Y>
Ice Cream: {Vanilla}: <Y> Chocolate:<Y>
Fruit Salad: <Y>