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F
T
THE AMERICAN RED CROSS NURSING SERVICE
FORM 1193
REV. 11-26-34
an
5
PHYSICAL EXAMINATION
C
e
(Follow instructions at end of form in answering all questions)
S
1. Name of applicant miss Jeanses Bacan.
Address
City Fermington State michegan
2. Age
22
Height
63"
Weight 189.
C
3. General physique will developed dened naurished.
e
4. to or
membert Tendency disease, inherited otherwise had the
5. Previous history in regard to illness or injury
Greendestend 1937.
Vision: no
Left Right eye; eye; Distant Distant vision vision 3% the Corrected Corrected to to - - Lens Lens used used
no
Note* Actual vision should be deternined on proper letters for 20 foot distant,
Date 4/19/38
as 20-20,20-30,20-100,etc. If glasses are worn state correction. M.B.
georgia
voice your /15'
Left ear; Watch good /40"
Whispered voice good /15'
8. Teeth and gums: (note
NOTE-Check chart
abnormalities) on other side of blank. good call ditional chanding
9. Neck: (Thyroid glands and other abnormalities)
my
10. Spine and extremities: (bones, joints, muscles and feet) me
11.
Thorax: Respiratory system, bronchi, lungs, pleura, etc Sung clear,
Expiration 34
inches
Inspiration 36
inches
Respiration 20 per minute
Cardio-vascular system 200 enlargement
Heart: (note all signs of cardiac involvement) send
Immussus
Pulse 98 Blood pressure: S. 108 D 58,
(Over)
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"ocrText": "F\nT\nTHE AMERICAN RED CROSS NURSING SERVICE\nFORM 1193\nREV. 11-26-34\nan\n5\nPHYSICAL EXAMINATION\nC\ne\n(Follow instructions at end of form in answering all questions)\nS\n1. Name of applicant miss Jeanses Bacan.\nAddress\nCity Fermington State michegan\n2. Age\n22\nHeight\n63\"\nWeight 189.\nC\n3. General physique will developed dened naurished.\ne\n4. to or\nmembert Tendency disease, inherited otherwise had the\n5. Previous history in regard to illness or injury\nGreendestend 1937.\nVision: no\nLeft Right eye; eye; Distant Distant vision vision 3% the Corrected Corrected to to - - Lens Lens used used\nno\nNote* Actual vision should be deternined on proper letters for 20 foot distant,\nDate 4/19/38\nas 20-20,20-30,20-100,etc. If glasses are worn state correction. M.B.\ngeorgia\nvoice your /15'\nLeft ear; Watch good /40\"\nWhispered voice good /15'\n8. Teeth and gums: (note\nNOTE-Check chart\nabnormalities) on other side of blank. good call ditional chanding\n9. Neck: (Thyroid glands and other abnormalities)\nmy\n10. Spine and extremities: (bones, joints, muscles and feet) me\n11.\nThorax: Respiratory system, bronchi, lungs, pleura, etc Sung clear,\nExpiration 34\ninches\nInspiration 36\ninches\nRespiration 20 per minute\nCardio-vascular system 200 enlargement\nHeart: (note all signs of cardiac involvement) send\nImmussus\nPulse 98 Blood pressure: S. 108 D 58,\n(Over)\nBest Available Image"
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