Basically, this form has not been changed for about 50 years.
For those interested:
Favus is a scalp fungus, easily treatable with a modern antifungal.
Framboesia and/or yaws (two names for more or less the same thing) is a rather horrible ulcerating disease that can destroy your bones… But it’s easily treatable with penicillin, and accordingly its prevalence was reduced by 95% sometime in the 1960s.
And so now you know: I don’t have syphilis. Nor am I an imbecile. Here’s an excerpt of my interaction with the doctor at the walk-in clinic:
ME: So, I’m going to Botswana, and I need this medical form filled out.
DOCTOR: [TAKES FORM] Oh, Botswana, that’s interesting.. where is that again? Will you need any lab tests for this?
ME: It’s just above South Africa. And.. tests.. well, I don’t think so. Have a look.
DOCTOR: [ACTUALLY READS FORM, RAISES EYEBROWS] … Really?
DOCTOR: Well, you don’t look like an idiot… Do you have syphilis?
ME: Pretty sure I don’t.
DOCTOR: Okay. [SIGNS FORM]
Thus certified as being free of all the important contagions and mental illnesses, I was permitted to reside in the country of Botswana.