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Form 1193
Rev. March 1942
AMERICAN RED CROSS
Report of Physical Condition of Nurse
(Please answer all questions completely and accurately)
Applicant can answer all questions herself, except number 6, with which she will need assistance.
1. Name
m e Candlinh
Frauen
Archer
(Last)
(First)
(Middle)
2. Age 48
Height 5714 wells inches
Weight
145
pounds
3. Family history : Indicate, in the space opposite the disease, which member of your family, if any, has had
the following, and when. Cross out those which no one has had.
Tuberculosis-
Were you a contact?
Cancer,
Diabetes
Heart disease
Epilepsy
Mental illness
4. Past medical history : General health
good -
Operations-specify nature of, and year
Appendictomy
1914
Tomilestone 1918 - fall bladder remend 1933
Injuries-specify
Illnesses-cross out the ones which you have not had. Indicate the dates when you had the others
:
Allergic conditions
Arthritis
Cancer
Communicable diseases (specify) measles . clinduan fox. whooking Cough
Diabetes
Hay fever
Heart disease
Hypertension
Migraine
Nervous or mental
Rheumatic fever
Sinusitis
Have you ever had Pulmonary Tuberculosis ? If so, when
Where did you cure?
Is the condition now arrested?
Have you ever had a suspected
Pulmonary Tuberculosis ?
If so, when
Others-specify
5. General physique-cross out those which do not apply.
Frail
Good
Robust
Thirr
Slender
Obese
OVER
Page data
- Page
- 23
- Source index
- 0
- Type
- photo
- Media ID
- 7d35edab46c4bebc
- Size
- unknown
Document data
- ID
- 2661919
- Core
- doc
- Type
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DTO data
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Context sent to Scholar
Document identity
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"ocrText": "Form 1193\nRev. March 1942\nAMERICAN RED CROSS\nReport of Physical Condition of Nurse\n(Please answer all questions completely and accurately)\nApplicant can answer all questions herself, except number 6, with which she will need assistance.\n1. Name\nm e Candlinh\nFrauen\nArcher\n(Last)\n(First)\n(Middle)\n2. Age 48\nHeight 5714 wells inches\nWeight\n145\npounds\n3. Family history : Indicate, in the space opposite the disease, which member of your family, if any, has had\nthe following, and when. Cross out those which no one has had.\nTuberculosis-\nWere you a contact?\nCancer,\nDiabetes\nHeart disease\nEpilepsy\nMental illness\n4. Past medical history : General health\ngood -\nOperations-specify nature of, and year\nAppendictomy\n1914\nTomilestone 1918 - fall bladder remend 1933\nInjuries-specify\nIllnesses-cross out the ones which you have not had. Indicate the dates when you had the others\n:\nAllergic conditions\nArthritis\nCancer\nCommunicable diseases (specify) measles . clinduan fox. whooking Cough\nDiabetes\nHay fever\nHeart disease\nHypertension\nMigraine\nNervous or mental\nRheumatic fever\nSinusitis\nHave you ever had Pulmonary Tuberculosis ? If so, when\nWhere did you cure?\nIs the condition now arrested?\nHave you ever had a suspected\nPulmonary Tuberculosis ?\nIf so, when\nOthers-specify\n5. General physique-cross out those which do not apply.\nFrail\nGood\nRobust\nThirr\nSlender\nObese\nOVER"
}