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N A
D M R 29
THE AMERICAN RED CROSS
e
a
NURSING SERVICE
e
Physical Examination
I. Name of applicant Manual Tiblels
C
M
Address 5210-12n.E. City Seaute State WA
35
2.
General Age physique This Height
641/ Weight 105
rs.
3.
4. Tendency to disease, inherited or otherwise my
The
T
5. Previous history in regard to serious illness surgical operation apper declong
(A
or
1914
5
F
Has she had rheumatism? no
O
6.
7. Has she at present or has she ever had hernia? no
8. Condition
9. hard
of teeth and - one musing -
S
Condition of feet
Abdomen and contained Normal
IO. II. Chest and contained organs organs " about 6yod
Girth; expiration
30
inches; inspiration
35 inches
16
Respiration, rate of
Heart, pulse rate 72
Right eye (Snellen)
20/8 ; corrected to
; lens used
I2. Vision:
Left eye
(Snellen) 20/20 ; corrected
to
; lens used
13. Hearing: A. D 15/15
A. S.
15/15
14. Urine examination:
Color amter
Reaction acid
Specific gravity 1015
Albumen them
Casts none
Leucocytes. none
Sugar Zome
15. Do you recommend applicant for:
OK
(a) hospital you
General service
all
(b) Tropical service
16. Fill in name and number of base hospital, unit or detachment with which applicant is connected:
Army base hospital
Pediatric Unit
5
Naval base hospital
11
Emergency detachment
Navy detachment
Hospital unit
M.
D.
Date 12/24/15
Address 50 8 Cobe Blkg
All questions MUST be answered; otherwise certificate will not be accepted at head=
quarters.
To be forwarded to Chief Nurse of Unit or to Committee Organizing Detachment.
Req. 7-2125B-20M-Nov.
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"ocrText": "N A\nD M R 29\nTHE AMERICAN RED CROSS\ne\na\nNURSING SERVICE\ne\nPhysical Examination\nI. Name of applicant Manual Tiblels\nC\nM\nAddress 5210-12n.E. City Seaute State WA\n35\n2.\nGeneral Age physique This Height\n641/ Weight 105\nrs.\n3.\n4. Tendency to disease, inherited or otherwise my\nThe\nT\n5. Previous history in regard to serious illness surgical operation apper declong\n(A\nor\n1914\n5\nF\nHas she had rheumatism? no\nO\n6.\n7. Has she at present or has she ever had hernia? no\n8. Condition\n9. hard\nof teeth and - one musing -\nS\nCondition of feet\nAbdomen and contained Normal\nIO. II. Chest and contained organs organs \" about 6yod\nGirth; expiration\n30\ninches; inspiration\n35 inches\n16\nRespiration, rate of\nHeart, pulse rate 72\nRight eye (Snellen)\n20/8 ; corrected to\n; lens used\nI2. Vision:\nLeft eye\n(Snellen) 20/20 ; corrected\nto\n; lens used\n13. Hearing: A. D 15/15\nA. S.\n15/15\n14. Urine examination:\nColor amter\nReaction acid\nSpecific gravity 1015\nAlbumen them\nCasts none\nLeucocytes. none\nSugar Zome\n15. Do you recommend applicant for:\nOK\n(a) hospital you\nGeneral service\nall\n(b) Tropical service\n16. Fill in name and number of base hospital, unit or detachment with which applicant is connected:\nArmy base hospital\nPediatric Unit\n5\nNaval base hospital\n11\nEmergency detachment\nNavy detachment\nHospital unit\nM.\nD.\nDate 12/24/15\nAddress 50 8 Cobe Blkg\nAll questions MUST be answered; otherwise certificate will not be accepted at head=\nquarters.\nTo be forwarded to Chief Nurse of Unit or to Committee Organizing Detachment.\nReq. 7-2125B-20M-Nov."
}