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OCR
5
(OAOI)
bayae
BTOOG a
13. Abdomen: (condition of wall, scars, herniae, and abnormality of viscera)
3
Rt sectur sear no abionalities
Circumference 33
of abdomen at umbilicus
14. Nervous system: (note organic or functional disorders)
beu
Physicilogical
15. Urinalysis: Sp. Gr. 1023 Albumin
Jucpoa
Tuopee
0
Sugar o
Microscopical
Floe. Rediment
Squam epich
unate crystals
acid reaction
amber color
16. Date of immunization against, Smallpox
1937
Typhoid no
17. Remarks on abnormalities not otherwise noted or sufficiently described on this blank:
JO' neok none
a' JULOTP
If duty (Military, Disaster, etc.?) yes
Is the applicant fit to perform active
not, state type of duty she is physically fitted to perform
Date
Henry l.blore
Examiner
aus
motu
sento
5600 Greene At
10
13
se
Collecreg
n
A
17
18 19 20 21 22 23 24 25 26 27 28 29 30
31
32
31
UTEPOLA:
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.
12. Chest measurements should be in total inches.
EXVWIAV.LIOW
VWEBICVA KED CHO28
9
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