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D M R Form No. 29
pH
N
I
NURSING SERVICE
etc-
S
THE j
S
PHYSICAL EXAMINATION
(b
I. Name of applicant Evongelen H morkan
Address 2854A. Moplessord City Checo
State lee
2. Age
25
Height
5'8"
Weight 137
Mrs.
3. General physique
Ven good
None
E
4. Tendency to disease, inherited or otherwise
L
5. Previous history in regard to serious illness or surgical operation Diflette 1915
H,
no
or
6. Has she had rheumatism?
7. Has she at present or has she ever had hernia?
no
M
8. Condition of teeth
grand
9. Condition of feet
good
IO. Abdomen Gert
and contained organs
II. Chest and contained organs
Normal
I
Expiration
24
inches.
Inspiration
82 1/2
inches.
I2. Vision: O. D.
/20
Noemal
Hearing: A. D.
normal
Normal
A. S.
normal
O. S.
/20
NOTE: In case of refractive error state degree of correction by glasses.
13. Urine examination:
Pule Stron
and
Reaction
Color
1020
Albumen
none
Specific gravity
Leucocytes
now
Casts.
Sugar
none
14. Do you recommend applicant for:
(a) General hospital service
Mr
(b) Tropical service
yes
15. Fill in location of base hospital, unit or detachment with which service is desired:
Army base hospital at
6K
Naval base hospital at
CNC
Emergency detachment at
Navy detachment at
Hospital unit at
Surgical section at
M.
D.
Date left.
Address 104 So Miliganth
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-~20M
Page data
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- Source index
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- Type
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- Media ID
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Document data
- ID
- 2661368
- Core
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- Type
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"ocrText": "D M R Form No. 29\npH\nN\nI\nNURSING SERVICE\netc-\nS\nTHE j\nS\nPHYSICAL EXAMINATION\n(b\nI. Name of applicant Evongelen H morkan\nAddress 2854A. Moplessord City Checo\nState lee\n2. Age\n25\nHeight\n5'8\"\nWeight 137\nMrs.\n3. General physique\nVen good\nNone\nE\n4. Tendency to disease, inherited or otherwise\nL\n5. Previous history in regard to serious illness or surgical operation Diflette 1915\nH,\nno\nor\n6. Has she had rheumatism?\n7. Has she at present or has she ever had hernia?\nno\nM\n8. Condition of teeth\ngrand\n9. Condition of feet\ngood\nIO. Abdomen Gert\nand contained organs\nII. Chest and contained organs\nNormal\nI\nExpiration\n24\ninches.\nInspiration\n82 1/2\ninches.\nI2. Vision: O. D.\n/20\nNoemal\nHearing: A. D.\nnormal\nNormal\nA. S.\nnormal\nO. S.\n/20\nNOTE: In case of refractive error state degree of correction by glasses.\n13. Urine examination:\nPule Stron\nand\nReaction\nColor\n1020\nAlbumen\nnone\nSpecific gravity\nLeucocytes\nnow\nCasts.\nSugar\nnone\n14. Do you recommend applicant for:\n(a) General hospital service\nMr\n(b) Tropical service\nyes\n15. Fill in location of base hospital, unit or detachment with which service is desired:\nArmy base hospital at\n6K\nNaval base hospital at\nCNC\nEmergency detachment at\nNavy detachment at\nHospital unit at\nSurgical section at\nM.\nD.\nDate left.\nAddress 104 So Miliganth\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-~20M"
}