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D
5
a
e
Division Lake
QUESTIONNAIRE
The
Date 5/15/rr
1. Name
Jennis B. anderson
2. Address - Temporary
1231 Girl an alio
Permanent
Same
3. Red Cross Badge Number.
A
6411
4. Date of appointment to service. nlay 6- 1917
0322 M
5. Date of discharge from service. mayra 1919
e
6, Service with - Arny
Navy
Red Cross
B
U.S. Public Health Service, Sanitary Zone.
Emergency, Influenza, Epidemic, Disaster, etc.
7. Condition of health on discharge.
good
8. Condition of health at present time. good
9. Approximate date of illness if any and where.
-
10. Have you notified the Vet. Bureau, or the Red Cross Nursing Service? -
11. Are Date you drawing compensation from the Vet. Bureau?
granted.
-
Number.
Hospitalization if any.
Name and address of doctor by whon examined.
12. Remarks:
13. Vocational Training.
Number.
Where.
What Kind.
Length of Course.
14. Remarks:
-
15, Are Date you drawing Insurance from the American F.ed Cross?
granted.
-
16. Present occupation. Public Health Thank
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- Core
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"ocrText": "D\n5\na\ne\nDivision Lake\nQUESTIONNAIRE\nThe\nDate 5/15/rr\n1. Name\nJennis B. anderson\n2. Address - Temporary\n1231 Girl an alio\nPermanent\nSame\n3. Red Cross Badge Number.\nA\n6411\n4. Date of appointment to service. nlay 6- 1917\n0322 M\n5. Date of discharge from service. mayra 1919\ne\n6, Service with - Arny\nNavy\nRed Cross\nB\nU.S. Public Health Service, Sanitary Zone.\nEmergency, Influenza, Epidemic, Disaster, etc.\n7. Condition of health on discharge.\ngood\n8. Condition of health at present time. good\n9. Approximate date of illness if any and where.\n-\n10. Have you notified the Vet. Bureau, or the Red Cross Nursing Service? -\n11. Are Date you drawing compensation from the Vet. Bureau?\ngranted.\n-\nNumber.\nHospitalization if any.\nName and address of doctor by whon examined.\n12. Remarks:\n13. Vocational Training.\nNumber.\nWhere.\nWhat Kind.\nLength of Course.\n14. Remarks:\n-\n15, Are Date you drawing Insurance from the American F.ed Cross?\ngranted.\n-\n16. Present occupation. Public Health Thank"
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