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THE AMERICAN RED CROSS NURSING SERVICE
FORM 1193
REV. 11-26-34
11
clines
PHYSICAL EXAMINATION
S
et
acose
your
T
B°
(Follow instructions at end of form in answering all questions)
VIT. 1. Name of applicant miss fear adkerson
dr
Address 1228 Stanhopeler City Rickmand
gocebpog State Va
2. Age 33
Height 68"
Weight 130
3. General physique
good
4. Tendency to disease, inherited or otherwise none
Previous history in regard to illness or injury General health good
L
5.
Has had grappe and diphthesis and acute middle ear.
20
6. Vision: Right eye; Distant vision 20
Corrected to
Lens used
zo
Left eye; Distant vision 20 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.
If glasses are worn state correction.
7. Hearing: Right ear; Watch
4.0 /40"
Whispered voice
15/15'
IL
Left ear; Watch
40 /40"
Whispered voice
8. Teeth and gums : (note abnormalities)
OK.
NOTE-Check chart on other side of blank.
9. Neck: (Thyroid glands and other abnormalities)
normal
TO
10. normal save
Spine and extremities: (bones, joints, muscles and feet)
for small calluses under balls of feet
11. Thorax: Respiratory system, bronchi, lungs, pleura, etc
normal
Expiration Inspiration 33Y2
inches
Expiration Inspiration 31 1/2
inches
12
gb
Respiration
19
per minute
Cardio-vascular system
normal.
17°
Heart: (note all signs of cardiac involvement)
IS: vpgomeu of
Functional syntotic mutmur in pulmonia area
Pulse 75 Blood pressure: S. 135 D 86
(Over)
9
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"ocrText": "D\na\n&\nTHE AMERICAN RED CROSS NURSING SERVICE\nFORM 1193\nREV. 11-26-34\n11\nclines\nPHYSICAL EXAMINATION\nS\net\nacose\nyour\nT\nB°\n(Follow instructions at end of form in answering all questions)\nVIT. 1. Name of applicant miss fear adkerson\ndr\nAddress 1228 Stanhopeler City Rickmand\ngocebpog State Va\n2. Age 33\nHeight 68\"\nWeight 130\n3. General physique\ngood\n4. Tendency to disease, inherited or otherwise none\nPrevious history in regard to illness or injury General health good\nL\n5.\nHas had grappe and diphthesis and acute middle ear.\n20\n6. Vision: Right eye; Distant vision 20\nCorrected to\nLens used\nzo\nLeft eye; Distant vision 20 Corrected to\nLens used\nNOTE:-Actual vision should be determined on proper letters for 20 foot distant, as 20-20, 20-30, 20-100, etc.\nIf glasses are worn state correction.\n7. Hearing: Right ear; Watch\n4.0 /40\"\nWhispered voice\n15/15'\nIL\nLeft ear; Watch\n40 /40\"\nWhispered voice\n8. Teeth and gums : (note abnormalities)\nOK.\nNOTE-Check chart on other side of blank.\n9. Neck: (Thyroid glands and other abnormalities)\nnormal\nTO\n10. normal save\nSpine and extremities: (bones, joints, muscles and feet)\nfor small calluses under balls of feet\n11. Thorax: Respiratory system, bronchi, lungs, pleura, etc\nnormal\nExpiration Inspiration 33Y2\ninches\nExpiration Inspiration 31 1/2\ninches\n12\ngb\nRespiration\n19\nper minute\nCardio-vascular system\nnormal.\n17°\nHeart: (note all signs of cardiac involvement)\nIS: vpgomeu of\nFunctional syntotic mutmur in pulmonia area\nPulse 75 Blood pressure: S. 135 D 86\n(Over)\n9"
}