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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

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Document data

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2661919
Core
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Type
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Document identity
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Document source extras
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Page context
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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"
}