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OCR
F
0
+
(A
(OAOL)
+
13. Abdomen: (condition of wall, scars, herniae, and abnormality of viscera) has l
ep
5
Circumference of abdomen at umbilicus
25%
14. Nervous system: organic or
(note functional disorders) Two
18
box
15. Urinalysis: Sp. Gr. Albumin Meg Sugar they Microscopical negative
a
16. Date of immunization against, Smallpox
1936
Typhoid 1940
17. Remarks on abnormalities not otherwise noted or sufficiently described on this blank:
10
amon
a
Is the applicant fit to perform active duty (Military, Disaster, etc. ?) yes
9'
If not, state type of duty she is physically fitted to perform
Date Oct 17,1940
thank @ Cirtuan Inde
Examiner
50.50 50-30
to
(
Collecreg to
7
8
9
10
"
12
13
n
IAT
17
18 19 20 21 22 23 24 25 26.27 28 29 30 31
32
I-
Indicate missing teeth by "X", bridge work by C crowns by
plates by word
"plate".
GLO W. Marleus D.DS.
All questions MUST be answered; otherwise certificate will not be accepted at Head-
quarters. To be forwarded to the Local Committee on Red Cross Nursing Service.
dereapous)
1.
Be sure that all items are filled in before forwarding. Make definite statements in all instances.
2. Give age in years, height in inches, weight in pounds.
EXYWIAVLIOM
12. Chest measurements should be in total inches.
8
BEHAICE
hown 1189
22
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