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FORM 1193
AMERICAN RED CROSS NURSING SERVICE
REV. 10-26-38
am
PHYSICAL EXAMINATION
(Follow instructions at end of form in answering all questions)
H
1. Name of applicant
Ida M. Britton
a
a
Address
Mary Lanning Hospitaty
Hastings
State
Nebr.
2. Age 1B1
30 years
Height
5ft. 43in.
Weight
1272 lbs
3. Family history not significant
M
4. Past history: General health, operation, injury, any illnesses
a
no injuries, tonsillectomy 1932, no illnesses since childhood, measles,
4
mumps; whouping cough; snrallpox; in childhood
a
5. General physique
wellirdeveloped; mutrition good
C
20
6. Eyes: Pupils; Right eye; Distant vision 20/30 Corrected to
Lens used -.50
20
Left eye; Distant vision 20/35 Corrected
to
20
Lens used -62
20
NOTE:Actual vision should be determined on proper letters for 20 foot distant, as 20-20,20-30,20-100, etc.
If glasses are worn state correction.
7. Ears:
no discharge, hearing normal
lower third molars absent,
8. Teeth and gums: (note abnormalities)
NOTE:-Check chart on other side of blank.
9. Throat
10. Neck: (Thyroid gland and other abnormalitiest)hyroidno enlarged, no adenopathy.
11. Skeletal: (Bones, joints, muscles and feet) no deformities, good posture, feet
normal,
32in.
Inspiration
353in.
12. Thorax: Expiration
inches
inches
I8
Respiration
per minute
normal
Lungs to percussion and auscultation
8
Cardio-vascular system
normal
Heart: Size
normal
Murmurs
none
Pulse
70 per min.
Blood pressure: S
II5
D
70
(Over)
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"ocrText": "?\n+\ncall\nFORM 1193\nAMERICAN RED CROSS NURSING SERVICE\nREV. 10-26-38\nam\nPHYSICAL EXAMINATION\n(Follow instructions at end of form in answering all questions)\nH\n1. Name of applicant\nIda M. Britton\na\na\nAddress\nMary Lanning Hospitaty\nHastings\nState\nNebr.\n2. Age 1B1\n30 years\nHeight\n5ft. 43in.\nWeight\n1272 lbs\n3. Family history not significant\nM\n4. Past history: General health, operation, injury, any illnesses\na\nno injuries, tonsillectomy 1932, no illnesses since childhood, measles,\n4\nmumps; whouping cough; snrallpox; in childhood\na\n5. General physique\nwellirdeveloped; mutrition good\nC\n20\n6. Eyes: Pupils; Right eye; Distant vision 20/30 Corrected to\nLens used -.50\n20\nLeft eye; Distant vision 20/35 Corrected\nto\n20\nLens used -62\n20\nNOTE:Actual vision should be determined on proper letters for 20 foot distant, as 20-20,20-30,20-100, etc.\nIf glasses are worn state correction.\n7. Ears:\nno discharge, hearing normal\nlower third molars absent,\n8. Teeth and gums: (note abnormalities)\nNOTE:-Check chart on other side of blank.\n9. Throat\n10. Neck: (Thyroid gland and other abnormalitiest)hyroidno enlarged, no adenopathy.\n11. Skeletal: (Bones, joints, muscles and feet) no deformities, good posture, feet\nnormal,\n32in.\nInspiration\n353in.\n12. Thorax: Expiration\ninches\ninches\nI8\nRespiration\nper minute\nnormal\nLungs to percussion and auscultation\n8\nCardio-vascular system\nnormal\nHeart: Size\nnormal\nMurmurs\nnone\nPulse\n70 per min.\nBlood pressure: S\nII5\nD\n70\n(Over)"
}