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H
D M R Form No. 29
THE AMERICAN RED CROSS
B
I
CENTRAL DIVISION HEADQUARTERS
180 NORTH WABASH AVENUE
ED 74
CHICAGO, ILL.
e
a
+
Home Service
NURSING SERVICE
+
PHYSICAL EXAMINATION
Esteller R. Weetman
ES
1. Name of applicant
M
Address Turchase Reese Hospital City
Cheaps
State Jee
1
(^
2. Age
26
Height
64 in
Weight 122
Good
=
3. General physique
e
4. Tendency to disease, inherited or otherwise none
E
K /
5. Previous history in regard to serious illness or surgical operation Had operation for exophthal.
+
Tuic goitre in 1913. Excellent results. kophohalmos persists & while
1
a
had rheumatism? (now) runs from 72-80 2 if aree
N
=
6.
Has
she
increase under examination > to subside
7. Has she at present or has she ever had hernia? no
again in a pew
8. Condition of teeth
ok.
condurance of health excellent
It.
R
9. Condition of feet
OK,
10. Abdomen and contained organs
negative
11. Chest and contained organs
negative
Expiration
30 1/2 inches.
Inspiration
34 1/4 inches.
12. Vision: O. D
20/20
4 20
Hearing: A. D
o.S.
70/20
A. S
20/20
NOTE: In case of refractive error state degree of correction by glasses.
13. Urine examination:
Color straw
Reaction
acid
Specific
gravity 1022
Albumen
0
Casts
0
Leucocytes
O
Sugar
0
OK
14. Do you recommend applicant for:
(a) General hospital service
Yes
alls
(b) Tropical service.
no
15. Fill in location of base hospital, unit or detachment with which service is desired:
Army base hospital at
Naval base hospital at
Emergency detachment at
Navy detachment at
Hospital unit at
Surgical section at
M. D.
Date
April 22,1918
Address 104 So mich. aves.
All questions MUST be answered; otherwise certificate will not be accepted at headquarters.
To be forwarded to Chief Nurse of Unit or to Committee Organizing Detachment.
Req. 17-833-1-3-18-20M
Loo
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Document data
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- Type
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"ocrText": "H\nD M R Form No. 29\nTHE AMERICAN RED CROSS\nB\nI\nCENTRAL DIVISION HEADQUARTERS\n180 NORTH WABASH AVENUE\nED 74\nCHICAGO, ILL.\ne\na\n+\nHome Service\nNURSING SERVICE\n+\nPHYSICAL EXAMINATION\nEsteller R. Weetman\nES\n1. Name of applicant\nM\nAddress Turchase Reese Hospital City\nCheaps\nState Jee\n1\n(^\n2. Age\n26\nHeight\n64 in\nWeight 122\nGood\n=\n3. General physique\ne\n4. Tendency to disease, inherited or otherwise none\nE\nK /\n5. Previous history in regard to serious illness or surgical operation Had operation for exophthal.\n+\nTuic goitre in 1913. Excellent results. kophohalmos persists & while\n1\na\nhad rheumatism? (now) runs from 72-80 2 if aree\nN\n=\n6.\nHas\nshe\nincrease under examination > to subside\n7. Has she at present or has she ever had hernia? no\nagain in a pew\n8. Condition of teeth\nok.\ncondurance of health excellent\nIt.\nR\n9. Condition of feet\nOK,\n10. Abdomen and contained organs\nnegative\n11. Chest and contained organs\nnegative\nExpiration\n30 1/2 inches.\nInspiration\n34 1/4 inches.\n12. Vision: O. D\n20/20\n4 20\nHearing: A. D\no.S.\n70/20\nA. S\n20/20\nNOTE: In case of refractive error state degree of correction by glasses.\n13. Urine examination:\nColor straw\nReaction\nacid\nSpecific\ngravity 1022\nAlbumen\n0\nCasts\n0\nLeucocytes\nO\nSugar\n0\nOK\n14. Do you recommend applicant for:\n(a) General hospital service\nYes\nalls\n(b) Tropical service.\nno\n15. Fill in location of base hospital, unit or detachment with which service is desired:\nArmy base hospital at\nNaval base hospital at\nEmergency detachment at\nNavy detachment at\nHospital unit at\nSurgical section at\nM. D.\nDate\nApril 22,1918\nAddress 104 So mich. aves.\nAll questions MUST be answered; otherwise certificate will not be accepted at headquarters.\nTo be forwarded to Chief Nurse of Unit or to Committee Organizing Detachment.\nReq. 17-833-1-3-18-20M\nLoo"
}