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DMR Form No. 29
THE AMERICAN RED CROSS
CENTRAL DIVISION HEADQUARTERS
180 NORTH WABASH AVENUE
CHICAGO, ILL.
NURSING SERVICE
PHYSICAL EXAMINATION
1. Name of applicant Tittman , Anna Louise
TemporarAddress Box 64 ,Whittier Hall-1230 Amsterdam City Ave.
New York State New York
Permanent
11
% W.A.Tittman -RFD #1 Springfield- Illinois.
2. Age 37.
Height 4111 (59 ) L.L. (withou without Weight 126 lb. wahnet sleaes us
3. General physique. good
methory door
clactiving
4. Tendency to disease, inherited or otherwise None
5. Previous history in regard to serious illness or surgical operation Pneumonia at 3 years ;
light attack Scarlet fever as a chied.
6. Has she had rheumatism? no
7. Has she at present or has she ever had hernia? no
8. Condition of teeth Excellent
9. Condition of feet good
10. Abdomen and contained organs negative
11. Chest and contained organs normal
Expiration
29%
inches.
Inspiration 33
inches.
12.
Vision : O. D. 20/20 for st.50 cyluidrials Hearing: A. D. 15/15
20/20
study+.50
.
O. S
A. S. 15/15
NOTE: In case of refractive error state degree of correction by glasses.
13. Urine examination:
Color. Pale auther
Reaction acid
Specific gravity 1.020
Albumen absent
Casts
none
Leucocytes normal
Sugar
absent
14. Do you recommend applicant for:
(a) General hospital service yes
(b) Tropical service
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
Hospital unit at
Surgical section at
the A. Suverne.
M. D.
Date 3/13/22
Address
611 W-110 Sr.
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. 17-833-1-3-18-20m
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Document data
- ID
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- Core
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- Type
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DTO data
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Context sent to Scholar
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"ocrText": "DMR Form No. 29\nTHE AMERICAN RED CROSS\nCENTRAL DIVISION HEADQUARTERS\n180 NORTH WABASH AVENUE\nCHICAGO, ILL.\nNURSING SERVICE\nPHYSICAL EXAMINATION\n1. Name of applicant Tittman , Anna Louise\nTemporarAddress Box 64 ,Whittier Hall-1230 Amsterdam City Ave.\nNew York State New York\nPermanent\n11\n% W.A.Tittman -RFD #1 Springfield- Illinois.\n2. Age 37.\nHeight 4111 (59 ) L.L. (withou without Weight 126 lb. wahnet sleaes us\n3. General physique. good\nmethory door\nclactiving\n4. Tendency to disease, inherited or otherwise None\n5. Previous history in regard to serious illness or surgical operation Pneumonia at 3 years ;\nlight attack Scarlet fever as a chied.\n6. Has she had rheumatism? no\n7. Has she at present or has she ever had hernia? no\n8. Condition of teeth Excellent\n9. Condition of feet good\n10. Abdomen and contained organs negative\n11. Chest and contained organs normal\nExpiration\n29%\ninches.\nInspiration 33\ninches.\n12.\nVision : O. D. 20/20 for st.50 cyluidrials Hearing: A. D. 15/15\n20/20\nstudy+.50\n.\nO. S\nA. S. 15/15\nNOTE: In case of refractive error state degree of correction by glasses.\n13. Urine examination:\nColor. Pale auther\nReaction acid\nSpecific gravity 1.020\nAlbumen absent\nCasts\nnone\nLeucocytes normal\nSugar\nabsent\n14. Do you recommend applicant for:\n(a) General hospital service yes\n(b) Tropical service\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\nHospital unit at\nSurgical section at\nthe A. Suverne.\nM. D.\nDate 3/13/22\nAddress\n611 W-110 Sr.\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. 17-833-1-3-18-20m"
}