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DMR 29-N.E.D.
THE AMERICAN RED CROSS
DEPARTMENT OF NURSING
Students
St
Physical Examination
1. Name of applicant
ada Holder stafford
Address 87 Lanh SV.
City Prndium State R.1
2. Age
41
Height 5-7
Weight
146
3. General physique
Ereat. healthy
4. Tendency to disease, inherited or otherwise
none
5. Previous history in regard to serious illness or surgical operation M1416- orariou eyet
remord there menstruates normally
6. Has she had rheumatism ?
Two
7. Has she at present or has she ever had hernia
no
8. Condition of teeth
good
9. Condition of feet
good
10. Abdomen and contained organs
normal
11. Chest and contained organs.
bour
normal
Girth; expiration
33
inches; inspiration
36
inches
Respiration, rate of
/18
Heart, pulse rate
76
Right eye (Snellen
Vyra
; corrected to
; lens used
12. Vision
Left eye (Snellen
8/20
; corrected to
; lens used
13. A. D normal
Hearing:
A. S
turnal
14. Urine examination:
Color
marker
Reaction
and
Specific gravity
1013
Albumen
0
Casts
0
Leucocytes
0
Sugar
0
15. Do you recommend applicant for:
(a) General hospital service
ys
Ry
(b) Tropical service
yes
In Mc water
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 63
Perking the
Navy detachment
Hospital unit
Date frem 15,1918
Halsey and
M. D.
Address. or Brook 8r. R.I
All questions MUST be answered; otherwise certificate will not be accepted at
headquarters.
To be forwarded to Chief Nurse of Unit or to the Local Committee Organizing
Detachment on Red Cross Nursing Service.
(SEE OTHER SIDE)
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"ocrText": "DMR 29-N.E.D.\nTHE AMERICAN RED CROSS\nDEPARTMENT OF NURSING\nStudents\nSt\nPhysical Examination\n1. Name of applicant\nada Holder stafford\nAddress 87 Lanh SV.\nCity Prndium State R.1\n2. Age\n41\nHeight 5-7\nWeight\n146\n3. General physique\nEreat. healthy\n4. Tendency to disease, inherited or otherwise\nnone\n5. Previous history in regard to serious illness or surgical operation M1416- orariou eyet\nremord there menstruates normally\n6. Has she had rheumatism ?\nTwo\n7. Has she at present or has she ever had hernia\nno\n8. Condition of teeth\ngood\n9. Condition of feet\ngood\n10. Abdomen and contained organs\nnormal\n11. Chest and contained organs.\nbour\nnormal\nGirth; expiration\n33\ninches; inspiration\n36\ninches\nRespiration, rate of\n/18\nHeart, pulse rate\n76\nRight eye (Snellen\nVyra\n; corrected to\n; lens used\n12. Vision\nLeft eye (Snellen\n8/20\n; corrected to\n; lens used\n13. A. D normal\nHearing:\nA. S\nturnal\n14. Urine examination:\nColor\nmarker\nReaction\nand\nSpecific gravity\n1013\nAlbumen\n0\nCasts\n0\nLeucocytes\n0\nSugar\n0\n15. Do you recommend applicant for:\n(a) General hospital service\nys\nRy\n(b) Tropical service\nyes\nIn Mc water\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 63\nPerking the\nNavy detachment\nHospital unit\nDate frem 15,1918\nHalsey and\nM. D.\nAddress. or Brook 8r. R.I\nAll questions MUST be answered; otherwise certificate will not be accepted at\nheadquarters.\nTo be forwarded to Chief Nurse of Unit or to the Local Committee Organizing\nDetachment on Red Cross Nursing Service.\n(SEE OTHER SIDE)"
}