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BT
3
at
ga
N
B. If a wife, is she now pregnant?
B now
XI. Has the applicant ever had-
XI.
A. Rheumatism, acute or chronic?
A none
+
B. Malaria?
B none
or
C. Other fever?
C none
T
D. Any disease or injury not included in pre-
D none
ceding questions?
XII. Has the applicant noticed any recent marked
XII. Gain
gain or loss in flesh?
XIII. Would you recommend the applicant to a
XIII. yes.
reputable Life Insurance Company as a pru-
dent risk?
XIV. Do you professionally consider the applicant
XIV. yes
a suitable person, physically, for appointment
to overseas work?
XV. Would a tropical climate be likely to induce
XV. no.
disease or cause disablement?
XVI. Are there any facts known to you, or dis-
XVI. none
covered by you, not brought out in the above
questions, affecting or likely to affect the
health of the applicant? If so, please state
them.
XVII. Is there, in general, a soundness of constitu-
tion and a vigor of health which give reason-
XVII. yes
able probability that the applicant can endure
the physical and mental strain of overseas
work?
XVIII. When was the applicant last successfully
XVIII. -
vaccinated?
XIX. Has the applicant had typhoid fever or the
anti-typhoid inoculation ?
XIX. m
NOTE
Before final credentials are issued to any person enrolled for foreign service for the American Red Cross, a
certificate or certificates must be furnished of vaccination and inoculation against smallpox, typhoid and para-
typhoid fever, or in lieu thereof, a certificate by a physician, approved by the Medical Adviser of the Division
receiving the ap oplication, that such person has recently suffered from the disease for the prevention of which there
has been no immunization by vaccination or preventive inoculation.
2
Signature of Medical Examiner
M. D.
Address tranfital Benaklyn 4.y
5
Page data
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Document data
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DTO data
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"ocrText": "BT\n3\nat\nga\nN\nB. If a wife, is she now pregnant?\nB now\nXI. Has the applicant ever had-\nXI.\nA. Rheumatism, acute or chronic?\nA none\n+\nB. Malaria?\nB none\nor\nC. Other fever?\nC none\nT\nD. Any disease or injury not included in pre-\nD none\nceding questions?\nXII. Has the applicant noticed any recent marked\nXII. Gain\ngain or loss in flesh?\nXIII. Would you recommend the applicant to a\nXIII. yes.\nreputable Life Insurance Company as a pru-\ndent risk?\nXIV. Do you professionally consider the applicant\nXIV. yes\na suitable person, physically, for appointment\nto overseas work?\nXV. Would a tropical climate be likely to induce\nXV. no.\ndisease or cause disablement?\nXVI. Are there any facts known to you, or dis-\nXVI. none\ncovered by you, not brought out in the above\nquestions, affecting or likely to affect the\nhealth of the applicant? If so, please state\nthem.\nXVII. Is there, in general, a soundness of constitu-\ntion and a vigor of health which give reason-\nXVII. yes\nable probability that the applicant can endure\nthe physical and mental strain of overseas\nwork?\nXVIII. When was the applicant last successfully\nXVIII. -\nvaccinated?\nXIX. Has the applicant had typhoid fever or the\nanti-typhoid inoculation ?\nXIX. m\nNOTE\nBefore final credentials are issued to any person enrolled for foreign service for the American Red Cross, a\ncertificate or certificates must be furnished of vaccination and inoculation against smallpox, typhoid and para-\ntyphoid fever, or in lieu thereof, a certificate by a physician, approved by the Medical Adviser of the Division\nreceiving the ap oplication, that such person has recently suffered from the disease for the prevention of which there\nhas been no immunization by vaccination or preventive inoculation.\n2\nSignature of Medical Examiner\nM. D.\nAddress tranfital Benaklyn 4.y\n5"
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