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FORM 1193
AMERICAN RED CROSS NURSING SERVICE
REV. 10-26-38
(stebalv
PHYSICAL EXAMINATION
(Follow instructions at end of form in answering all questions)
1. Name of applicant
White, CAtheRINe h.
Address 28ChAmbeRs Street
City PRINCetoN
State N.J
2.
Age 274RS 3MO, Height 5' 10"
Weight 160
3. Family history
M.X.F. 2 brother e. of
which
4. Past history: General health, operation, injury, any illnesses
T.A.A. 1918 Appendentory 1929
5. General physique
excellent
A
6. Eyes: Pupils; Right eye; Distant vision
Corrected to
Lens used
gease insurancy Left
eye; Distant vision
Corrected to
Lens used
NOTE:-Actual vision should be determined on proper letters for 20 foot distant, as 20-20, 20-30, 20-100, etc.
,
3
If glasses are worn state correction.
1
7. Ears:
OK
8. Teeth and gums: (note abnormalities)
None
NOTE:-Check chart on other side of blank.
9. Throat
OK
10. Neck: (Thyroid gland and other abnormalities)
ok.
11. Skeletal: (Bones, joints, muscles and feet)
ok.
----------------------------
12. Thorax: Expiration
3b
inches
Inspiration
3914
inches
Respiration
18
per minute
Lungs to percussion and auscultation
Vegative
Cardio-vascular system
Negatine
Heart: Size
Normal
Nork
Murmurs
Pulse
8 2
Blood pressure: S 122
D 78
(Over)
82311
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"ocrText": "FORM 1193\nAMERICAN RED CROSS NURSING SERVICE\nREV. 10-26-38\n(stebalv\nPHYSICAL EXAMINATION\n(Follow instructions at end of form in answering all questions)\n1. Name of applicant\nWhite, CAtheRINe h.\nAddress 28ChAmbeRs Street\nCity PRINCetoN\nState N.J\n2.\nAge 274RS 3MO, Height 5' 10\"\nWeight 160\n3. Family history\nM.X.F. 2 brother e. of\nwhich\n4. Past history: General health, operation, injury, any illnesses\nT.A.A. 1918 Appendentory 1929\n5. General physique\nexcellent\nA\n6. Eyes: Pupils; Right eye; Distant vision\nCorrected to\nLens used\ngease insurancy Left\neye; Distant vision\nCorrected to\nLens used\nNOTE:-Actual vision should be determined on proper letters for 20 foot distant, as 20-20, 20-30, 20-100, etc.\n,\n3\nIf glasses are worn state correction.\n1\n7. Ears:\nOK\n8. Teeth and gums: (note abnormalities)\nNone\nNOTE:-Check chart on other side of blank.\n9. Throat\nOK\n10. Neck: (Thyroid gland and other abnormalities)\nok.\n11. Skeletal: (Bones, joints, muscles and feet)\nok.\n----------------------------\n12. Thorax: Expiration\n3b\ninches\nInspiration\n3914\ninches\nRespiration\n18\nper minute\nLungs to percussion and auscultation\nVegative\nCardio-vascular system\nNegatine\nHeart: Size\nNormal\nNork\nMurmurs\nPulse\n8 2\nBlood pressure: S 122\nD 78\n(Over)\n82311"
}