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    • Bigley, Loretta I.

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    Page 113 of 126
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    to B. If a wife, is she now pregnant? B Single XI. Has the applicant ever had- XI. A. Rheumatism, acute or chronic? A no it B. Malaria? B no C. no. et It C. Other fever? D. Any disease or injury not included in pre- D none P ceding questions? XII. no H XII. Has the applicant noticed any recent marked gain or loss in flesh? C XIII. Would you recommend the applicant to a XIII. reputable Life Insurance Company as a pru- yes dent risk? +, + XIV. Do you professionally consider the applicant XIV. a suitable person, physically, for appointment ges to overseas work? N be XV. Would a tropical climate be likely to induce XV. no. disease or cause disablement? E XVI, Are there any facts known to you, or dis- XVI. none covered by you, not brought out in the above x questions, affecting or likely to affect the health of the applicant? If so, please state p them. XVII. Is there, in general, a soundness of constitu- XVII. yes. tion and a vigor of health which give reason- able probability that the applicant can endure the physical and mental strain of overseas work XVIII. When was the applicant last successfully XVIII. vaccinated? Jan. negative june 1912 - (4th XIX. Has the applicant had typhoid fever or the anti-typhoid inoculation? XIX. yes $ NOTE Before final credentials are issued to any person enrolled for foreign service for the American Red Cross, a certificate or certificates must be furnished of vaccination and inoculation against smallpox, typhoid and para- typhoid fever, or in lieu thereof, a certificate by a physician, approved by the Medical Adviser of the Division receiving the application) that such person has recently suffered from the disease for the prevention of which there has been no immunization by vaccination or preventive inoculation. Signature of Medical Examiner. CPINE Culting D. Address 122 smich are elucagones 2

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    "ocrText": "to\nB. If a wife, is she now pregnant?\nB\nSingle\nXI. Has the applicant ever had-\nXI.\nA. Rheumatism, acute or chronic?\nA\nno\nit\nB. Malaria?\nB\nno\nC.\nno.\net\nIt\nC. Other fever?\nD. Any disease or injury not included in pre-\nD none\nP\nceding questions?\nXII.\nno\nH\nXII. Has the applicant noticed any recent marked\ngain or loss in flesh?\nC\nXIII. Would you recommend the applicant to a\nXIII.\nreputable Life Insurance Company as a pru-\nyes\ndent risk?\n+,\n+\nXIV. Do you professionally consider the applicant\nXIV.\na suitable person, physically, for appointment\nges\nto overseas work?\nN\nbe\nXV. Would a tropical climate be likely to induce\nXV.\nno.\ndisease or cause disablement?\nE\nXVI, Are there any facts known to you, or dis-\nXVI.\nnone\ncovered by you, not brought out in the above\nx\nquestions, affecting or likely to affect the\nhealth of the applicant? If so, please state\np\nthem.\nXVII. Is there, in general, a soundness of constitu-\nXVII.\nyes.\ntion and a vigor of health which give reason-\nable probability that the applicant can endure\nthe physical and mental strain of overseas\nwork\nXVIII. When was the applicant last successfully\nXVIII.\nvaccinated?\nJan. negative\njune 1912 - (4th\nXIX. Has the applicant had typhoid fever or the\nanti-typhoid inoculation?\nXIX.\nyes\n$\nNOTE\nBefore final credentials are issued to any person enrolled for foreign service for the American Red Cross, a\ncertificate or certificates must be furnished of vaccination and inoculation against smallpox, typhoid and para-\ntyphoid fever, or in lieu thereof, a certificate by a physician, approved by the Medical Adviser of the Division\nreceiving the application) that such person has recently suffered from the disease for the prevention of which there\nhas been no immunization by vaccination or preventive inoculation.\nSignature of Medical Examiner. CPINE Culting D.\nAddress 122 smich are\nelucagones\n2"
}