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FORM 1193
THE AMERICAN RED CROSS NURSING SERVICE
REV. 10-22-36
11
3
PHYSICAL EXAMINATION
i
(Follow instructions at end of form in answering all questions)
1. Name
of applicant Doroily E Luding
Address 42 Beard are City Buffalo State my
2. Age
35
Height 5'4"
Weight 121
Rouse
3. General physique
4. Tendency to disease, inherited or otherwise none
5. Previous history in regard to operation, injury or illness Tensilietory 1923.
Secondary anema 1930,
6. Vision: Right eye; Distant vision 20/20:7 Corrected to 20/13 Lens used +12 x90
5
Left eye; Distant vision. 20/20. t Corrected to 20/15 Lens used +as x 90
NOTE:-Actual vision should be determined on proper letters for 20 foot distant, as 20-20, 20-30, 20-100, etc.
If glasses are worn state correction.
7. Hearing: Right ear; Watch
Prifact. /40" (AOR
Whispered voice voic Perfect /15' /15'
Left ear; Watch
Whispered
8.
Teeth and gums: (note abnormalities) blank. Herispine good Condition AEB
NOTE-Ched chart on other side of
9. Neck: (Thyroid glands and other abnormalities) hofenlarged
to palpation inspection
10. Spine and extremities; (bones, joints, muscles and feet) normal,
feel nor feat.
11. Thorax: Respiratory system, lungs,
bronchi, pleura, etc. normal
28
32
Expiration
inches
Inspiration
inches
8
Respiration 14
per minute
Cardio-vascular system no abnormalites
Heart: (note all signs of cardiac involvement) none
Pulse 80
Blood pressure: S 122 D 80
(Over)
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"ocrText": "FORM 1193\nTHE AMERICAN RED CROSS NURSING SERVICE\nREV. 10-22-36\n11\n3\nPHYSICAL EXAMINATION\ni\n(Follow instructions at end of form in answering all questions)\n1. Name\nof applicant Doroily E Luding\nAddress 42 Beard are City Buffalo State my\n2. Age\n35\nHeight 5'4\"\nWeight 121\nRouse\n3. General physique\n4. Tendency to disease, inherited or otherwise none\n5. Previous history in regard to operation, injury or illness Tensilietory 1923.\nSecondary anema 1930,\n6. Vision: Right eye; Distant vision 20/20:7 Corrected to 20/13 Lens used +12 x90\n5\nLeft eye; Distant vision. 20/20. t Corrected to 20/15 Lens used +as x 90\nNOTE:-Actual vision should be determined on proper letters for 20 foot distant, as 20-20, 20-30, 20-100, etc.\nIf glasses are worn state correction.\n7. Hearing: Right ear; Watch\nPrifact. /40\" (AOR\nWhispered voice voic Perfect /15' /15'\nLeft ear; Watch\nWhispered\n8.\nTeeth and gums: (note abnormalities) blank. Herispine good Condition AEB\nNOTE-Ched chart on other side of\n9. Neck: (Thyroid glands and other abnormalities) hofenlarged\nto palpation inspection\n10. Spine and extremities; (bones, joints, muscles and feet) normal,\nfeel nor feat.\n11. Thorax: Respiratory system, lungs,\nbronchi, pleura, etc. normal\n28\n32\nExpiration\ninches\nInspiration\ninches\n8\nRespiration 14\nper minute\nCardio-vascular system no abnormalites\nHeart: (note all signs of cardiac involvement) none\nPulse 80\nBlood pressure: S 122 D 80\n(Over)"
}