Medical Officer's Checklist
A Medical Officer's Checklist. It states that Lisa has no history of institutionalization or psychological treatment, no mental disturbances, no chronic diseases, no venereal diseases, no "infestation", is not senile, and has no dental problems that will require extensive work and no physical or mental problems that will cause Lisa to need medical treatment later.
The form says that Lisa cannot have ANY of these problems. However, the person filling out the form checks "no" regarding "chronic non-optimum physical condition or debility," but goes on to note that Lisa "does have bad headaches every 3 months with are paralysing (hurt a lot) for 1-2 hrs."