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L.C Peremal
-
QUESTIONNAIRE
1.
Name Envice a Smith
2.
Address - Temporary General Hospital Roelevater nep.
Permanent 311 High streel Newbompport mass.
3.
Red Cross Badge Number 1230
25
921
4.
Date of appointment to service may 1978
5,
Date of discharge from service June 1919
to
6.
Service with Army may 1918 TO February 1919
"
"
Navy
(11/6/15)
"
"
Red Cross February 1919th June 1919.
"
"
United States Public Health Service Sanitary Zone
"
"
Emergency, Influenza Epidemic, Disaster, etc.
7.
Condition of health on discharge. very tired otherwinggone
8.
Condition of health at present time. gind
9. Approximate date of illness if any and where. none
10. Have you notified the Veterans Bureau or
the Red Cross Nursing Service? no
Ll. Are you drawing compensation from the Veterans Bureau? no
Date granted.
Number.
Hospitalization if any.
JAN
Name and address of doctor by whom examined.
I
28
1922
12. Remarks:
13. Vocational Training. no
Number
Where
What kind.
Length of course.
14. Remarks:
15. the American Red Cross? no
Are you drawing Insurance from
Date granted.
16. Present Cocupation.
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- 2662269
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"ocrText": "L.C Peremal\n-\nQUESTIONNAIRE\n1.\nName Envice a Smith\n2.\nAddress - Temporary General Hospital Roelevater nep.\nPermanent 311 High streel Newbompport mass.\n3.\nRed Cross Badge Number 1230\n25\n921\n4.\nDate of appointment to service may 1978\n5,\nDate of discharge from service June 1919\nto\n6.\nService with Army may 1918 TO February 1919\n\"\n\"\nNavy\n(11/6/15)\n\"\n\"\nRed Cross February 1919th June 1919.\n\"\n\"\nUnited States Public Health Service Sanitary Zone\n\"\n\"\nEmergency, Influenza Epidemic, Disaster, etc.\n7.\nCondition of health on discharge. very tired otherwinggone\n8.\nCondition of health at present time. gind\n9. Approximate date of illness if any and where. none\n10. Have you notified the Veterans Bureau or\nthe Red Cross Nursing Service? no\nLl. Are you drawing compensation from the Veterans Bureau? no\nDate granted.\nNumber.\nHospitalization if any.\nJAN\nName and address of doctor by whom examined.\nI\n28\n1922\n12. Remarks:\n13. Vocational Training. no\nNumber\nWhere\nWhat kind.\nLength of course.\n14. Remarks:\n15. the American Red Cross? no\nAre you drawing Insurance from\nDate granted.\n16. Present Cocupation."
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