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D MR Form No. 29
R BH 12
uz
THE MERICAN REDE CROSS
NURSING SERVICE
WATUMANITY ASHINGTON D
PHYSICAL EXAMINATION
I. Name of applicant
Margory Force
Address
3250 Floridayme City Chicago State Henoris
2. Age
35
Height 5 ft Sin Weight 163
3. General physique.
Robush
4. Tendency to disease, inherited or otherwise Reg-mone inheride d
10 1
5. Previous history in regard to serious illness or surgical operation
Typhoid fever in 1906
6. Has she had rheumatism?
no
7. Has she at present or has she ever had hernia? no
8. Condition of teeth
good
9. Condition of feet
OK
IO. Abdomen and contained organs
normal
II. Chest and contained organs
normal
Expiration
36 1/2
inches.
Inspiration 34
inches.
12. Vision: O. D.
/20 VI
Hearing: A. D.
normal
O. S.
/20 VI
A.S.
normal
NOTE: In case of refractive error state degree of correction by glasses.
13. Urine examination:
Color amber
Reaction neutral
Specific gravity
1018
Albumen
o
Casts
none
Leucocytes
a
Sugar.
O
14. Do you recommend applicant for:
Reen wended
(a) General hospital service.
(b) Tropical service
Recom mended
15. Fill in location of base hospital, unit or detachment with which service is desired:
Army base hospital at
Naval base hospital at
Emergency detachment at
Navy detachment at
Hospital unit at
Surgical section at
F.P. Cyneha
M. D.
Date 7-30-19
Address 2501.00 springfield are
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 MR Form No. 29\nR BH 12\nuz\nTHE MERICAN REDE CROSS\nNURSING SERVICE\nWATUMANITY ASHINGTON D\nPHYSICAL EXAMINATION\nI. Name of applicant\nMargory Force\nAddress\n3250 Floridayme City Chicago State Henoris\n2. Age\n35\nHeight 5 ft Sin Weight 163\n3. General physique.\nRobush\n4. Tendency to disease, inherited or otherwise Reg-mone inheride d\n10 1\n5. Previous history in regard to serious illness or surgical operation\nTyphoid fever in 1906\n6. Has she had rheumatism?\nno\n7. Has she at present or has she ever had hernia? no\n8. Condition of teeth\ngood\n9. Condition of feet\nOK\nIO. Abdomen and contained organs\nnormal\nII. Chest and contained organs\nnormal\nExpiration\n36 1/2\ninches.\nInspiration 34\ninches.\n12. Vision: O. D.\n/20 VI\nHearing: A. D.\nnormal\nO. S.\n/20 VI\nA.S.\nnormal\nNOTE: In case of refractive error state degree of correction by glasses.\n13. Urine examination:\nColor amber\nReaction neutral\nSpecific gravity\n1018\nAlbumen\no\nCasts\nnone\nLeucocytes\na\nSugar.\nO\n14. Do you recommend applicant for:\nReen wended\n(a) General hospital service.\n(b) Tropical service\nRecom mended\n15. Fill in location of base hospital, unit or detachment with which service is desired:\nArmy base hospital at\nNaval base hospital at\nEmergency detachment at\nNavy detachment at\nHospital unit at\nSurgical section at\nF.P. Cyneha\nM. D.\nDate 7-30-19\nAddress 2501.00 springfield are\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"
}