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Thyroid
nmm.
Heart and vascular system nmul.
Systolic 145
Blood Pressure-
Diastolic
go
Lungs
nimal nr dullar W rules,
Abdomen
neg. Mr mann,
Hernia
nme.
Genito urinary system
negation,
Hemorrhoids nme.
Spine (including posture)
nmal Goal Pisten.
Extremities (deformities, lameness, atrophies, varicosities, scars, and other abnormalities)
nm
Reflexes nimal t =
Evidence of mental or nervous disease nms.
URINALYSIS
Sp. Gr. 1016
Albumen my
Leucocytes nm Casts nnu.
Reaction and Sugar
my
Erythrocytes nm
ADDITIONAL INFORMATION FOR WOMEN
Are regular? yes
menses
Prolonged? nv
Breasts? nr paus
Do they interfere with work? nr
Excessive? nv
Pregnancies? m
Smallpox you 1993 Date last vacc. 1943
IMMUNIZATION Typhoid
Dates last series 3/1/92
Other 1943 IM.)
Impletes
Office
In your opinion is this applicant physically fit to carry out duties in :
Field
Foreign Service
If a questionable risk, state reasons. God bandeduts)
Date
Signature: Examining Physician M.D.
Address: 204 Budbey
Street
Post Office
Note: Upon completion of the examination this form should be sent to :
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"ocrText": "Thyroid\nnmm.\nHeart and vascular system nmul.\nSystolic 145\nBlood Pressure-\nDiastolic\ngo\nLungs\nnimal nr dullar W rules,\nAbdomen\nneg. Mr mann,\nHernia\nnme.\nGenito urinary system\nnegation,\nHemorrhoids nme.\nSpine (including posture)\nnmal Goal Pisten.\nExtremities (deformities, lameness, atrophies, varicosities, scars, and other abnormalities)\nnm\nReflexes nimal t =\nEvidence of mental or nervous disease nms.\nURINALYSIS\nSp. Gr. 1016\nAlbumen my\nLeucocytes nm Casts nnu.\nReaction and Sugar\nmy\nErythrocytes nm\nADDITIONAL INFORMATION FOR WOMEN\nAre regular? yes\nmenses\nProlonged? nv\nBreasts? nr paus\nDo they interfere with work? nr\nExcessive? nv\nPregnancies? m\nSmallpox you 1993 Date last vacc. 1943\nIMMUNIZATION Typhoid\nDates last series 3/1/92\nOther 1943 IM.)\nImpletes\nOffice\nIn your opinion is this applicant physically fit to carry out duties in :\nField\nForeign Service\nIf a questionable risk, state reasons. God bandeduts)\nDate\nSignature: Examining Physician M.D.\nAddress: 204 Budbey\nStreet\nPost Office\nNote: Upon completion of the examination this form should be sent to :"
}