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I
D M R 29
THE AMERICAN RED CROSS
DEPARTMENT OF NURSING
Physical Examination
1. Name of applicant
Address nason Hospital City Roaring Appring State Pa.
Bertha Cameling mangle
Mrs.
2. Age 36
Height
5ft 2im Weight 130
3. General physique
Well proportioned
4. Tendency disease,
to inherited or otherwise none
5.
Previous history in regard to serious illness or surgical operation
never sick
q
Has had a goitre no pince proberty.
Nevey donabled
6. Has she had rheumatism ?
7. no
Has she at present or has she ever had hernia ?
8. Condition of teeth
food
9. Condition of feet
good
Normal
10. Abdomen and contained organs
11. contained Normal
Chest and organs
Girth; expiration
31
inches; inspiration
34
inches
Respiration, rate of
18
Heart, pulse rate 80
Right eye (Snellen) N20 ; corrected to 1575 ; lens used anio tyocly 1015
12. Vision :
Left eye (Snellen) 1545 ; corrected to 1515 ; lens used terricle
13. Hearing: A. D 20 ft
20 ft.
axis 757
A. S
14. Urine examination
Color straw
Acid
Reaction
Specific gravity 1018
none
Albumen
Casts none
Leucocytes none
Sugar none
(HC)
OK
15. Do you recommend applicant for :
(a) General hospital service
yes, but specially
for operating room work.
(b) Tropical service
16. Fill in name and number of base hospital, unit or detachment with which applicant is connected:
U
Army base hospital
N
Naval base hospital
8
Emergency detachment
Navy detachment
Hospital unit
W. AlbertMason
M. D
Date Jone 7,1918
Address Roaring spring Pa.
All questions MUST be answered; otherwise certificate will not be accepted at headqúarters.
To be forwarded to Chief Nurse of Unit or to Local Committee on Red Cross Nursing Service.
Req. 17-14224-1M-Mar.
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Document data
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- Core
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- Type
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"ocrText": "I\nD M R 29\nTHE AMERICAN RED CROSS\nDEPARTMENT OF NURSING\nPhysical Examination\n1. Name of applicant\nAddress nason Hospital City Roaring Appring State Pa.\nBertha Cameling mangle\nMrs.\n2. Age 36\nHeight\n5ft 2im Weight 130\n3. General physique\nWell proportioned\n4. Tendency disease,\nto inherited or otherwise none\n5.\nPrevious history in regard to serious illness or surgical operation\nnever sick\nq\nHas had a goitre no pince proberty.\nNevey donabled\n6. Has she had rheumatism ?\n7. no\nHas she at present or has she ever had hernia ?\n8. Condition of teeth\nfood\n9. Condition of feet\ngood\nNormal\n10. Abdomen and contained organs\n11. contained Normal\nChest and organs\nGirth; expiration\n31\ninches; inspiration\n34\ninches\nRespiration, rate of\n18\nHeart, pulse rate 80\nRight eye (Snellen) N20 ; corrected to 1575 ; lens used anio tyocly 1015\n12. Vision :\nLeft eye (Snellen) 1545 ; corrected to 1515 ; lens used terricle\n13. Hearing: A. D 20 ft\n20 ft.\naxis 757\nA. S\n14. Urine examination\nColor straw\nAcid\nReaction\nSpecific gravity 1018\nnone\nAlbumen\nCasts none\nLeucocytes none\nSugar none\n(HC)\nOK\n15. Do you recommend applicant for :\n(a) General hospital service\nyes, but specially\nfor operating room work.\n(b) Tropical service\n16. Fill in name and number of base hospital, unit or detachment with which applicant is connected:\nU\nArmy base hospital\nN\nNaval base hospital\n8\nEmergency detachment\nNavy detachment\nHospital unit\nW. AlbertMason\nM. D\nDate Jone 7,1918\nAddress Roaring spring Pa.\nAll questions MUST be answered; otherwise certificate will not be accepted at headqúarters.\nTo be forwarded to Chief Nurse of Unit or to Local Committee on Red Cross Nursing Service.\nReq. 17-14224-1M-Mar."
}