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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"
}