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F a 12. Abdomen and pelvis: (condition of wall, scars, herniae, and abnormality of viscera) 5 Seft Reart R2d scan C e Circumference of abdomen at umbilicus 28 the S 13. Urinalysis: Sp. Gr 1019 Albumin - Sugar - Microscopical 2.t fate A - 14. Nervous system: (note organic or functional disorders) C e 15. Has the applicant been recently immunized against, Smallpox fee Typhoid for 16. Remarks on abnormalities not otherwise noted or sufficiently described on this blank Is the to etc. If not, state type of duty she physically fitted to perform applicant fit perform is active duty (Military, Disaster, ?) fee Date July 13,1939 aB Therefore Examiner $ 2 s A 5 6 7 a 9 10 11 12 13 14 IS se y v K7 P A TA 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Indicate missing teeth by "X", bridge work by crowns by plates by word "plate". All questions MUST be answered; otherwise certificate will not be accepted at Head- quarters. To be forwarded to the Local Committee on Red Cross Nursing Service. 1. Be sure that all items are filled in before forwarding. Make definite statements in all instances. 2. Give age in years, height in inches, weight in pounds. 11. Chest measurements should be in total inches.

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