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D. M.R. FORM NO. 29
($13
THL MERICAN AMECUTRALITY TX CROSS
RED
AMERICAN RED CROSS NURSING SERVICE
WASHINGTONDO
PHYSICAL EXAMINATION
#
I. of applicant
Name Blanche Kacena
En Cedar bask
Address R.W- hong Hosp Indianapolis Ind.
2. Age 30
Height 66 Inches
Weight
120
#
3. General appearance well nourised OK
4. Tendency to disease, inherited or otherwise no
5.
Previous history in regard to serious illness or surgical operation Scarlet fever at 14,
Erpiplas of face no at 23- no operations
6. Have you had rheumatism?
7. Have you at present or have you ever had hernia?
no
8. Condition of teeth
good.
9. Condition of feet Very good
IO. Abdomen and contained organs nothing abnormal
II. Chest and contained organs nothing abnormal found
Expiration 30 1/2
inches.
Inspiration 33
inches.
12. Vision : O. D Conected
N20
Hearing: A. D.
or
O. S Conected
A. S.
or.
20
I3. Urine examination:
Color light amber
Reaction acid
Specific gravity 1010
Albumen neg.
Casts ney
Leucocytes occasional.
Sugar heg.
14. Remarks as to fitness of applicant for:
(a) General hospital service.
well fitted for hospital service.
Chypical condition good and
(b) Tropical
service same as (a)
G
J.Juenieh
M. D.
Date June 3- 1917
Address
1076 W. michigan it
Indianapolis, Ind.
To be forwarded to the Chairman National Committee on Nursing Service, American Red Cross,
Washington, D. C.
Req. 17-109-Feb.-3000.
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"ocrText": "D. M.R. FORM NO. 29\n($13\nTHL MERICAN AMECUTRALITY TX CROSS\nRED\nAMERICAN RED CROSS NURSING SERVICE\nWASHINGTONDO\nPHYSICAL EXAMINATION\n#\nI. of applicant\nName Blanche Kacena\nEn Cedar bask\nAddress R.W- hong Hosp Indianapolis Ind.\n2. Age 30\nHeight 66 Inches\nWeight\n120\n#\n3. General appearance well nourised OK\n4. Tendency to disease, inherited or otherwise no\n5.\nPrevious history in regard to serious illness or surgical operation Scarlet fever at 14,\nErpiplas of face no at 23- no operations\n6. Have you had rheumatism?\n7. Have you at present or have you ever had hernia?\nno\n8. Condition of teeth\ngood.\n9. Condition of feet Very good\nIO. Abdomen and contained organs nothing abnormal\nII. Chest and contained organs nothing abnormal found\nExpiration 30 1/2\ninches.\nInspiration 33\ninches.\n12. Vision : O. D Conected\nN20\nHearing: A. D.\nor\nO. S Conected\nA. S.\nor.\n20\nI3. Urine examination:\nColor light amber\nReaction acid\nSpecific gravity 1010\nAlbumen neg.\nCasts ney\nLeucocytes occasional.\nSugar heg.\n14. Remarks as to fitness of applicant for:\n(a) General hospital service.\nwell fitted for hospital service.\nChypical condition good and\n(b) Tropical\nservice same as (a)\nG\nJ.Juenieh\nM. D.\nDate June 3- 1917\nAddress\n1076 W. michigan it\nIndianapolis, Ind.\nTo be forwarded to the Chairman National Committee on Nursing Service, American Red Cross,\nWashington, D. C.\nReq. 17-109-Feb.-3000."
}