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AMERICAN RED CROSS NURSING SERVICE PHYSICAL EXAMINATION 1. Name of Applicant. Charlotte Elezabeth Van Duzar 2. Age 33 Height 5 but 8 1/2 in Weight 114 lbs. 3. General appearance Rather slender but well- nourished somewhat pale. 4. Are your parents living ? Both dead 5. If not, at what age and of what disease did each die? mother died atso from stomach trouble Father accidentally killed at 35. 6. Tendency to disease, inherited or otherwise ? None except fleurisy (?) 7. Previous history in regard to serious illness or surgical operation Pleurisy on Rt. side 4.y. ago. No recurrence 8. ? Have you had rheumatism No. 9. Have you at present or have you ever had hernia ? No. 10. Condition of teeth good 11. Condition of feet good 12. Abdomen and contained organs Nameal 13. Chest and contained organs Normal Expiration 29 % inches. Inspiration 32 1/4 inches. 14. Vision : O. D. well corrected Hearing : A.D. Excellent O.S. " - A. S. " 15. Urine Examination : Color amber Reaction acid Specific Gravity 1018 Albumen None Casts None Leucocytes accasional Sugar None 16. Remarks as to fitness of applicant for : (a) General hospital service Person is well and capable of much good hard work if given sufficient time offduty Tropical service 1 prolonged Ditto strain She will e he give presents out every under characteristic exceme for sleep asid rest (b) for herself much useful service, without risk to John m Hanfard M. D. Date ang 17 1914 Address 123 E. 62 St. N.y. city To be forwarded by the nurse, with duplicate Certificate of Immunity, to Chairman National Committee on Nursing Service, American Red Cross, Washington, D C. Prince

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    "ocrText": "AMERICAN RED CROSS NURSING SERVICE\nPHYSICAL EXAMINATION\n1. Name of Applicant.\nCharlotte Elezabeth Van Duzar\n2. Age\n33\nHeight\n5 but 8 1/2 in Weight\n114 lbs.\n3. General appearance Rather slender but well- nourished somewhat pale.\n4. Are your parents living\n? Both dead\n5. If not, at what age and of what disease did each die?\nmother died atso from\nstomach trouble Father accidentally killed at 35.\n6. Tendency to disease, inherited\nor otherwise ? None except fleurisy (?)\n7. Previous history in regard to serious illness or surgical operation\nPleurisy on Rt.\nside 4.y. ago. No recurrence\n8. ?\nHave you had rheumatism No.\n9. Have you at present or have you ever had hernia ?\nNo.\n10. Condition of teeth\ngood\n11. Condition of feet\ngood\n12. Abdomen and contained organs\nNameal\n13. Chest and contained organs\nNormal\nExpiration\n29 %\ninches.\nInspiration 32 1/4\ninches.\n14. Vision : O. D.\nwell corrected\nHearing : A.D.\nExcellent\nO.S.\n\"\n-\nA. S.\n\"\n15. Urine Examination :\nColor amber\nReaction\nacid\nSpecific Gravity\n1018\nAlbumen\nNone\nCasts\nNone\nLeucocytes accasional\nSugar\nNone\n16. Remarks as to fitness of applicant for :\n(a) General hospital service\nPerson is well and capable of much\ngood hard work if given sufficient time offduty\nTropical service 1 prolonged Ditto strain She will e he give presents out every under characteristic exceme\nfor sleep asid rest\n(b)\nfor herself much useful service, without risk to\nJohn m Hanfard M. D.\nDate ang 17 1914\nAddress\n123 E. 62 St.\nN.y. city\nTo be forwarded by the nurse, with duplicate Certificate of Immunity, to Chairman National Committee on\nNursing Service, American Red Cross, Washington, D C.\nPrince"
}