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1193-Rev. 2-9-22
Superseding D. M. R.29
THE AMERICAN RED CROSS NURSING SERVICE
N
PHYSICAL EXAMINATION
Name of applicant Eila E. me neil
Badge No.
1.
Address 38/12 W. arch It
City mansfield
State Onio
2. Age 24 yrs.
Height
5'212"
Weight 136#
3. General Physique. Healthy
4. Tendency to disease, inherited or otherwise no
5. Previous history in regard to serious illness or surgical operation none
6. Has she had rheumatism ? no
7. Has she at present or has she ever had hernia? no
8. Condition of teeth good
B
10. 9. Condition Abdomen Chest and of and contained contained organs good organs healthy healthy
feet
11.
Girth: Expiration 37
inches.
Inspiration
inches.
Respiration, rate of 18
Heart, pulse rate
72
20
Right eye (Snellen) 20 Corrected to
12. Vision:
20
lens used. Famal
Left eye (Snellen) 20
Corrected to
lens used
13. Hearing: A..D.
15/5
A. S.
the
1
14. Urine examination
Color amber
Reaction and
Specific
gravity 1020
Albumen no
Casts none
Leucocytes no
Sugar no
15. Do you recommend applicant for Active Hospital service? yes
Eum
M. D.
Date lan All questions 29-25 MUST be
Address
answered; otherwise certificate will not be accepted at Headquarters.
To be forwarded to the Local Committee on Red Cross Nursing Service.
1. Be sure that all items are filled in before forwarding. Make definite statements in all instances.
2. Give age in years, height in inches, weight in pounds, stating amount of clothing entering into weight.
8. State what teeth are missing and existing dentistry, such as crowns, plates, etc. State number of opposed molars.
9. Flat foot-state whether or not any inconvenience exists.
12. Actual vision should be stated, determined on proper letters for 20 foot distance, as 20/20,20/50,20/100.
11. Chest measurements should be in total inches.
If glasses
are worn state correction. Hearing should record whispered voice at 15 feet, 15/15, 10/15, etc.
4
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Document data
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"ocrText": "1193-Rev. 2-9-22\nSuperseding D. M. R.29\nTHE AMERICAN RED CROSS NURSING SERVICE\nN\nPHYSICAL EXAMINATION\nName of applicant Eila E. me neil\nBadge No.\n1.\nAddress 38/12 W. arch It\nCity mansfield\nState Onio\n2. Age 24 yrs.\nHeight\n5'212\"\nWeight 136#\n3. General Physique. Healthy\n4. Tendency to disease, inherited or otherwise no\n5. Previous history in regard to serious illness or surgical operation none\n6. Has she had rheumatism ? no\n7. Has she at present or has she ever had hernia? no\n8. Condition of teeth good\nB\n10. 9. Condition Abdomen Chest and of and contained contained organs good organs healthy healthy\nfeet\n11.\nGirth: Expiration 37\ninches.\nInspiration\ninches.\nRespiration, rate of 18\nHeart, pulse rate\n72\n20\nRight eye (Snellen) 20 Corrected to\n12. Vision:\n20\nlens used. Famal\nLeft eye (Snellen) 20\nCorrected to\nlens used\n13. Hearing: A..D.\n15/5\nA. S.\nthe\n1\n14. Urine examination\nColor amber\nReaction and\nSpecific\ngravity 1020\nAlbumen no\nCasts none\nLeucocytes no\nSugar no\n15. Do you recommend applicant for Active Hospital service? yes\nEum\nM. D.\nDate lan All questions 29-25 MUST be\nAddress\nanswered; otherwise certificate will not be accepted at Headquarters.\nTo be forwarded to the Local Committee on Red Cross Nursing Service.\n1. Be sure that all items are filled in before forwarding. Make definite statements in all instances.\n2. Give age in years, height in inches, weight in pounds, stating amount of clothing entering into weight.\n8. State what teeth are missing and existing dentistry, such as crowns, plates, etc. State number of opposed molars.\n9. Flat foot-state whether or not any inconvenience exists.\n12. Actual vision should be stated, determined on proper letters for 20 foot distance, as 20/20,20/50,20/100.\n11. Chest measurements should be in total inches.\nIf glasses\nare worn state correction. Hearing should record whispered voice at 15 feet, 15/15, 10/15, etc.\n4"
}