ALLERGY ASTHMA			RHEUMATOLOGY		ASSOCIATES
	1200 E. GENESEE STREET, SUITE 103     SYRACUSE, NEW YORK   13210
	MICHAEL SHEEHAN, MD      N. ANDREI POPESCU, MD    HARCHARAN SINGH, MD
NAME			DATE			DOB
						CHART #
STATEMENT OF PROBLEM
MEDICAL	ILLNESSES
ALLERGY	TO DRUGS			ALLERGY	TO FOODS
CURRENT	MEDICATIONS			HOSPITALIZATIONS/		SURGERIES