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D M R 29 THE AMERICAN RED CROSS DEPARTMENT OF NURSING Physical Examination 1. Name of applicant Mary ny Story Address 30 Hortense Street City Rochester State ny 2. Age 27yr Height 62 m Weight 1083/4/16 (lighted 3. General physique Good 4. Tendency to disease, inherited or otherwise Know of none 5. Previous history in regard to serious illness or surgical operation Sement / was with reppention at 8 yr 6. Has she had rheumatism ? no 7. Has she at present or has she ever had hernia ? no 8. Condition of teeth Good - Once upfer rt + once affect. morton musicing 9. Condition of feet Sight femention 2 the inconvening 10. Abdomen and contained organs no Enlargement massive L ten dereless 11. Chest and contained organs no abuaruisities B Girth; expiration 28. inches; inspiration 3014 inches Respiration, rate of 18 Heart, pulse rate 72 Right eye (Snellen) 9/10 corrected to ; lens used 12. Vision : Left eye (Snellen) 9/10 corrected to ; lens used 13. Hearing: A. D. O.K. 12/12 A. S. O.K. 12/12 14. Urine examination: Color Clear normal yellow Reaction Barely acid Specific gravity 1018 Albumen Possible trave Casts none Leucocytes Very few Sugar none 15. Do you recommend applicant for: (a) General hospital service yes (b) Tropical service 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 Lucium L. Bulton M. D. Date august 1 1925 Address 265 alexander street All questions MUST be answered; otherwise certificate will not be accepted at head- quarters. To be forwarded to Chief Nurse of Unit or to the Local Committee on Red Cross Nursing Service. (SEE OTHER SIDE)

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    "ocrText": "D M R 29\nTHE AMERICAN RED CROSS\nDEPARTMENT OF NURSING\nPhysical Examination\n1. Name of applicant Mary ny Story\nAddress\n30 Hortense Street\nCity Rochester\nState ny\n2. Age\n27yr\nHeight 62 m\nWeight 1083/4/16 (lighted\n3. General physique Good\n4. Tendency to disease, inherited or otherwise Know of none\n5. Previous history in regard to serious illness or surgical operation Sement / was with reppention\nat 8 yr\n6. Has she had rheumatism ? no\n7. Has she at present or has she ever had hernia ? no\n8.\nCondition of teeth Good - Once upfer rt + once affect. morton musicing\n9. Condition of feet Sight femention 2 the inconvening\n10. Abdomen and contained organs no Enlargement massive L ten dereless\n11. Chest and contained organs no abuaruisities\nB\nGirth; expiration 28.\ninches; inspiration 3014\ninches\nRespiration, rate of 18\nHeart, pulse rate 72\nRight eye (Snellen) 9/10\ncorrected to\n; lens used\n12. Vision :\nLeft eye (Snellen) 9/10\ncorrected to\n; lens used\n13. Hearing: A. D. O.K. 12/12\nA. S. O.K. 12/12\n14. Urine examination:\nColor Clear normal yellow\nReaction Barely acid\nSpecific gravity 1018\nAlbumen Possible trave\nCasts none\nLeucocytes Very few\nSugar none\n15. Do you recommend applicant for:\n(a) General hospital service yes\n(b) Tropical service\n16. Fill in name and number of base hospital, unit or detachment with which applicant is connected\n:\nArmy base hospital\nNaval base hospital\nEmergency detachment\nNavy detachment\nHospital unit\nLucium L. Bulton\nM. D.\nDate august 1 1925\nAddress 265 alexander street\nAll questions MUST be answered; otherwise certificate will not be accepted at head-\nquarters.\nTo be forwarded to Chief Nurse of Unit or to the Local Committee on Red Cross\nNursing Service.\n(SEE OTHER SIDE)"
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