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D M R Forín No. 29
(return to Room 36)
I
F
ear
F
NURSING SERVICE
e
4
PHYSICAL EXAMINATION
ASHINGTON
#2
I
3
Holen Muriel Godsoe.
I. Name of applicant
TS.
Address
149 Main St.
City New Canaan,
State
Conn.
31
2. Age
Height 5ft. 2in.
Weight
111 1bs.
M
I
Good.
3. General physique
4. Tendency to disease, inherited or otherwise No.
uri
5. Previous history in regard to serious illness or surgical operation
Appendix removed,
6. Has she had rheumatism?
No.
M
7. Has she at present or has she ever had hernia? No.
8.
Condition of teeth Plate upper, lower good
Su
C
9. Condition of feet
Normal.
I
IO. Abdomen and contained organs
Normal.
a
II. Chest and contained organs
Normal.
a
36
Expiration
33
inches.
Inspiration
36
inches.
I2. Vision: o. D.
/20
20/30
Hearing: A. D.
Normal
20/30.
O. S.
A. S.
Normal
/20
NOTE: In case of refractive error state degree of correction by glasses.
13. Urine examination:
Color
Amber,
Reaction
Acid,
Specific gravity
1020,
Albumen
Negative,
Casts
None seen,
Leucocytes
none seen,
Sugar
Negative,
14. Do you recommend applicant for:
(a) General hospital service
Yes,
of
(b) Tropical service
No,
15. Fill in location of base hospital, unit or detachment with which service is desired:
Army base hospital at
Naval base hospital at
Emergency detachment at
Navy detachment at
2
Hospital unit at
2
Surgical section at
Foreign service,
Date
June 14 /18.
New Canaan, Conn. M.
D.
20
Address.
6
All questions MUST be answered; otherwise certificate will not be accepted at headquarters.
To be forwarded to Chief Nurse of Unit or to Committee Organizing Detachment.
Req. 17-833-May--20M
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"ocrText": "D M R Forín No. 29\n(return to Room 36)\nI\nF\near\nF\nNURSING SERVICE\ne\n4\nPHYSICAL EXAMINATION\nASHINGTON\n#2\nI\n3\nHolen Muriel Godsoe.\nI. Name of applicant\nTS.\nAddress\n149 Main St.\nCity New Canaan,\nState\nConn.\n31\n2. Age\nHeight 5ft. 2in.\nWeight\n111 1bs.\nM\nI\nGood.\n3. General physique\n4. Tendency to disease, inherited or otherwise No.\nuri\n5. Previous history in regard to serious illness or surgical operation\nAppendix removed,\n6. Has she had rheumatism?\nNo.\nM\n7. Has she at present or has she ever had hernia? No.\n8.\nCondition of teeth Plate upper, lower good\nSu\nC\n9. Condition of feet\nNormal.\nI\nIO. Abdomen and contained organs\nNormal.\na\nII. Chest and contained organs\nNormal.\na\n36\nExpiration\n33\ninches.\nInspiration\n36\ninches.\nI2. Vision: o. D.\n/20\n20/30\nHearing: A. D.\nNormal\n20/30.\nO. S.\nA. S.\nNormal\n/20\nNOTE: In case of refractive error state degree of correction by glasses.\n13. Urine examination:\nColor\nAmber,\nReaction\nAcid,\nSpecific gravity\n1020,\nAlbumen\nNegative,\nCasts\nNone seen,\nLeucocytes\nnone seen,\nSugar\nNegative,\n14. Do you recommend applicant for:\n(a) General hospital service\nYes,\nof\n(b) Tropical service\nNo,\n15. Fill in location of base hospital, unit or detachment with which service is desired:\nArmy base hospital at\nNaval base hospital at\nEmergency detachment at\nNavy detachment at\n2\nHospital unit at\n2\nSurgical section at\nForeign service,\nDate\nJune 14 /18.\nNew Canaan, Conn. M.\nD.\n20\nAddress.\n6\nAll questions MUST be answered; otherwise certificate will not be accepted at headquarters.\nTo be forwarded to Chief Nurse of Unit or to Committee Organizing Detachment.\nReq. 17-833-May--20M"
}