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D M R Form No. 29 1 NURSING SERVICE 4 O PHYSICAL EXAMINATION I. Name of applicant. Mrs Ella Victoria Caquard Anthosope Address. 316.W.4 81 City North Little Rocks IStated and Age 45 Height 62 1/2 Weight 123ths E - 4. Tendency to disease//inherited or otherwise. no 3. General physique spain 5. Previous history in regard to serious illness or surgical operation Gaiter operation Remuval of truall gaites July 1916 6. Has she had rheumatism? Inflamitory no 7. Has she at present or has she ever had hernia? 8. Condition 9. Condition of feet normal of teeth Fais Firr forest lawnineisman bredya IO. Abdomen and contained organs Naxonal II. Chest and contained organs narmal Expiration 32 inches. Inspiration 35 inches. I2. Vision: D. D: 10/20 Hearing: A. D. 20/70 O. 5.10/20 A. S. Jelze NOTE: In case of refractive error state degree of correction by glasses. 13. Urine examination: Color amber Reaction acid Specific gravity 1018 Albumen name Casts name Leucocytes FEEN Sugar name 14. Do you recommend applicant for: (a) General hospital service yrs Ry emp (b) Tropical service 15. Fill in location of base hospital, unit or detachment with which service is desired: Army base hospital at Naval base hospital at 5 Emergency detachment at Navy detachment at 3 Hospital unit at Surgical section at Date Heh 27=1918 Address All questions MUST be answered; otherwise certificate will not be accepted at headquarters. To be forwarded to Chief Nurse of Unit or to Committee Organizing Detachment. Req. 17-833-May-2cM

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    "ocrText": "D\nM R Form No. 29\n1\nNURSING SERVICE\n4\nO\nPHYSICAL EXAMINATION\nI. Name of applicant. Mrs Ella Victoria Caquard\nAnthosope\nAddress. 316.W.4 81 City North Little Rocks IStated and\nAge 45\nHeight 62 1/2\nWeight 123ths\nE\n-\n4. Tendency to disease//inherited or otherwise. no\n3. General physique spain\n5. Previous history in regard to serious illness or surgical operation Gaiter operation\nRemuval of truall gaites July 1916\n6.\nHas she had rheumatism? Inflamitory no\n7. Has she at present or has she ever had hernia?\n8. Condition\n9. Condition of feet normal\nof teeth Fais Firr forest lawnineisman bredya\nIO.\nAbdomen and contained organs Naxonal\nII. Chest and contained organs\nnarmal\nExpiration\n32\ninches.\nInspiration\n35\ninches.\nI2. Vision: D. D: 10/20\nHearing: A. D. 20/70\nO. 5.10/20\nA. S.\nJelze\nNOTE: In case of refractive error state degree of correction by glasses.\n13. Urine examination:\nColor amber\nReaction acid\nSpecific gravity 1018\nAlbumen name\nCasts name\nLeucocytes FEEN\nSugar name\n14. Do you recommend applicant for:\n(a) General hospital service yrs\nRy\nemp\n(b) Tropical service\n15. Fill in location of base hospital, unit or detachment with which service is desired:\nArmy base hospital at\nNaval base hospital at\n5\nEmergency detachment at\nNavy detachment at\n3\nHospital unit at\nSurgical section at\nDate Heh 27=1918\nAddress\nAll questions MUST be answered; otherwise certificate will not be accepted at headquarters.\nTo be forwarded to Chief Nurse of Unit or to Committee Organizing Detachment.\nReq. 17-833-May-2cM"
}