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ED44
D. M. R. FORM NO,29
md 6643
AMERICAN RED CROSS NURSING SERVICE
4
PHYSICAL EXAMINATION
Aqui
A
I.
Name of applicant Agnos Pickett Floman
5
Address 115 11th at S.
rb
s
X
2.
Age 43 zio
Height
5 - 5
Weight 153th
3. General appearance Healthy
4. Tendency to disease, inherited or otherwise no
5. Previous history in regard to serious illness or surgical operation
camplete recovery
7. Have you at present or have you ever had hernia? Mo -
6. Have you had rheumatism? yes
8. Condition of teeth
roud
9. Condition of feet
road
IO. Abdomen and contained organs
normal
II. Chest and contained organs narmal
Expiration
35 inches.
Inspiration
38 inches.
I2.
Vision: o. D. narmal
Hearing: A.
D. normal
o. S narmal
A. S. mormal
13. Urine examination:
Color. amber
Reaction acid
Specific gravity 1030
Albumen no.
Casts no.
Leucocytes sew.
Sugar. no.
14. Remarks as to fitness of applicant for:
(a) General hospital service.
govef
(b) Tropical service. gover.
M. D.
Date May 29.1911
Address Feryo WW-
To be forwarded to the Chairman National Committee on Nursing Service, American Red Cross,
Washington, D. C.
REQ. 16-600-JULY-3M
like
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"ocrText": "ED44\nD. M. R. FORM NO,29\nmd 6643\nAMERICAN RED CROSS NURSING SERVICE\n4\nPHYSICAL EXAMINATION\nAqui\nA\nI.\nName of applicant Agnos Pickett Floman\n5\nAddress 115 11th at S.\nrb\ns\nX\n2.\nAge 43 zio\nHeight\n5 - 5\nWeight 153th\n3. General appearance Healthy\n4. Tendency to disease, inherited or otherwise no\n5. Previous history in regard to serious illness or surgical operation\ncamplete recovery\n7. Have you at present or have you ever had hernia? Mo -\n6. Have you had rheumatism? yes\n8. Condition of teeth\nroud\n9. Condition of feet\nroad\nIO. Abdomen and contained organs\nnormal\nII. Chest and contained organs narmal\nExpiration\n35 inches.\nInspiration\n38 inches.\nI2.\nVision: o. D. narmal\nHearing: A.\nD. normal\no. S narmal\nA. S. mormal\n13. Urine examination:\nColor. amber\nReaction acid\nSpecific gravity 1030\nAlbumen no.\nCasts no.\nLeucocytes sew.\nSugar. no.\n14. Remarks as to fitness of applicant for:\n(a) General hospital service.\ngovef\n(b) Tropical service. gover.\nM. D.\nDate May 29.1911\nAddress Feryo WW-\nTo be forwarded to the Chairman National Committee on Nursing Service, American Red Cross,\nWashington, D. C.\nREQ. 16-600-JULY-3M\nlike"
}