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D M R 29 THE AMERICAN RED CROSS NURSING SERVICE Physical Examination I. Name of applicant L Smith n. Address City 2. Age 40 Height 61 3/4 State y 3. General physique Robert Weight 127 4. Tendency to disease, inherited or otherwise name 5. Previous history in regard to serious illness or surgical operation Gall stores and appendictories questions 6. Has she had rheumatism? 7. Has she at present or has she ever had hernia? no 8. Condition of teeth Gourts 9. Condition of feet Slightly flat slight provotion IO. contained normal Abdomen and organs II. Chest and contained organs Lug nimal Girth; expiration. 32 inches; inspiration 36 aotic Diantal inches Mumue Respiration, rate of 18 Right eye (Snellen) 20/15 ; corrected to 20/15 Heart, pulse rate. metal execute Systome ; lens used +1.25-+250490 12. Vision: Left eye (Snellen) 20/15 ; corrected to 20/15 ; lens used M.252+25.90 I3. Hearing: A. D 20/20 A. S. 20/20 14. Urine examination: Color Pale Reaction acid Specific gravity 1020 Albumen none Casts name Leucocytes. name Cuse Reje Sugar none 15. Do you recommend applicant for: (a) General hospital service. No or private. Heart will Public not health, came trouble. special (b) Tropical service. no 16. Fill in name and number of base hospital, unit or detachment with which applicant is connected : Army base hospital. Naval base hospital Emergency detachment Navy detachment Hospital unit Thruse G Allus M. D. Date nov 27 1918 All questions MUST be answered; otherwise certificate will not be accepted at head- Address 439 Elk Buffawil st my quarters. To be forwarded to Chief Nurse of Unit or to Committee Organizing Detachment. Req. 17-2125B-20M-Nov.

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48
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0
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photo
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    "ocrText": "D M R 29\nTHE AMERICAN RED CROSS\nNURSING SERVICE\nPhysical Examination\nI. Name\nof applicant L Smith n.\nAddress City\n2. Age\n40\nHeight 61 3/4\nState y\n3. General physique Robert\nWeight 127\n4. Tendency to disease, inherited or otherwise name\n5. Previous history in regard to serious illness or surgical operation Gall stores and\nappendictories questions\n6. Has she had rheumatism?\n7. Has she at present or has she ever had hernia? no\n8. Condition of teeth Gourts\n9. Condition of feet Slightly flat slight provotion\nIO. contained normal\nAbdomen and organs\nII. Chest and contained organs Lug nimal\nGirth; expiration. 32\ninches; inspiration 36 aotic Diantal inches Mumue\nRespiration, rate of 18\nRight eye (Snellen) 20/15 ; corrected to 20/15\nHeart, pulse rate. metal execute Systome\n; lens used +1.25-+250490\n12. Vision:\nLeft eye (Snellen) 20/15 ; corrected to 20/15\n; lens used M.252+25.90\nI3. Hearing: A. D 20/20\nA. S. 20/20\n14. Urine examination:\nColor Pale\nReaction acid\nSpecific gravity 1020\nAlbumen none\nCasts\nname\nLeucocytes.\nname\nCuse\nReje\nSugar none\n15. Do you recommend applicant for:\n(a) General hospital service. No\nor private.\nHeart will Public not health, came trouble. special\n(b) Tropical service. no\n16. Fill in name and number of base hospital, unit or detachment with which applicant is connected :\nArmy base hospital.\nNaval base hospital\nEmergency detachment\nNavy detachment\nHospital unit\nThruse G Allus M. D.\nDate nov 27 1918\nAll questions MUST be answered; otherwise certificate will not be accepted at head-\nAddress 439 Elk Buffawil st my\nquarters.\nTo be forwarded to Chief Nurse of Unit or to Committee Organizing Detachment.\nReq. 17-2125B-20M-Nov."
}