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A
5
S
AMERICAN RED CROSS NURSING SERVICE
chier;
e
PHYSICAL EXAMINATION
1,
Name of Applicant. Antoinrtte Alochied
D
2. Age
35.
Height
aftlin
Weight 125
5
3.
General appearance Heathy
+
0
4. Are yout parents living
-
5. If not, at what age and of what disease did each die?
5
6. Tendency to disease, inherited or otherwise ?. nour
7.
Previous history in regard serious illness surgical operation Abunder 14 march
to or
ago for chronic mastitis book breats
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 eaph oursighted butwer
12. Abdomen and contained organs
13. Chest and contained organs
normal
Expiration
27
inches.
30
Inspiration
inches.
14. Vision : O.D.
my by
Hearing: A.D.
30 mind
20
O.S. to
-
A.S.
30 inch
15. Urine Examination :
Color shaw
Reaction
acid
Specific Gravity 1022
Albumen
now
Casts
now
Leucocytes
than
Sugar
non
16. Remarks as to fitness of applicant for :
(a) General hospital service
Find class
tired class
I
(b) Tropical service
-
s
Cimlingly
+
M. D.
Date aug, 3-16
Address. 301 swort
0
Dallas
To be forwarded by the-nurseywith duplicate Certificate of Immunity; to Chairman National Committee on
Nursing Service, American Red Cross, Washington, D C.
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Document data
- ID
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DTO data
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"ocrText": "A\n5\nS\nAMERICAN RED CROSS NURSING SERVICE\nchier;\ne\nPHYSICAL EXAMINATION\n1,\nName of Applicant. Antoinrtte Alochied\nD\n2. Age\n35.\nHeight\naftlin\nWeight 125\n5\n3.\nGeneral appearance Heathy\n+\n0\n4. Are yout parents living\n-\n5. If not, at what age and of what disease did each die?\n5\n6. Tendency to disease, inherited or otherwise ?. nour\n7.\nPrevious history in regard serious illness surgical operation Abunder 14 march\nto or\nago for chronic mastitis book breats\n8. Have you had rheumatism ?\nNo\n9. Have you at present or have you ever had hernia ? no\n10. Condition of teeth\nGood\n11. Condition\nof feet Good eaph oursighted butwer\n12. Abdomen and contained organs\n13. Chest and contained organs\nnormal\nExpiration\n27\ninches.\n30\nInspiration\ninches.\n14. Vision : O.D.\nmy by\nHearing: A.D.\n30 mind\n20\nO.S. to\n-\nA.S.\n30 inch\n15. Urine Examination :\nColor shaw\nReaction\nacid\nSpecific Gravity 1022\nAlbumen\nnow\nCasts\nnow\nLeucocytes\nthan\nSugar\nnon\n16. Remarks as to fitness of applicant for :\n(a) General hospital service\nFind class\ntired class\nI\n(b) Tropical service\n-\ns\nCimlingly\n+\nM. D.\nDate aug, 3-16\nAddress. 301 swort\n0\nDallas\nTo be forwarded by the-nurseywith duplicate Certificate of Immunity; to Chairman National Committee on\nNursing Service, American Red Cross, Washington, D C."
}