| ------------- Health Problems ------------- |
| Alcohol Abuse | Arthritis (Rheumatoid) |
| Asthma | Cancer |
| Crohn's Disease | Diabetes |
| Depression | Drug Abuse |
| Heart Problems | Hepatitis |
| High Blood Pressure | High Blood Pressure |
| Kidney Transplant | Liver Problems |
| Lung and Respiratory Problems | Lupus |
| Multiple Sclerosis | Overweight |
| Paralysis and Spinal Cord Injury | Parkinsons Disease |
| Seizures | Sleep Apnea |
| Stroke or TIA | OtherIllness |
--------- Activities and Lifestyle --------- |
| Aviation | Ballooning |
| Driving Record | Foreign Travel |
| Motorized Racing | Resident Alien |
| Rock & Mountain Climbing | SCUBA Diving |
| Sky Diving | Other Hazardous Activities |