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M R 29-N.E.D. THE AMERICAN RED CROSS DEPARTMENT OF NURSING 1sto * Physical Examination 1. Name of applicant Helen was Boylston Address 39Plearant ft City Pathmouth State N.H. 2. Age 35 you. Height 5'-5" Weight 125 lbe - thiffed I 3. General physique Excellent 4. inherited otherwise None Tendency to disease, or - to 5. Previous history in regard to serious illness or surgical operation Typhid 1908 appendictomy 1913 He delli su 6. Has she had rheumatism? the n som avio 0 7. has the 6m 016 dedor a Has she at present or she ever had hernia? 8. Condition of teeth Excellent 55. 9. Condition of feet Eveellent .0 10. Abdomen and contained organs Normal avalo .11 11. Chest and contained organs Normal Girth; expiration 29" inches; inspiration 32 inches Respiration, of 20 Heart, pulse rate 84 rate Right eye (Snellen) 20/30 ; corrected to 20/20 ; lens used 12. Vision: Left eye (Snellen) 20/20 ; correeted to 20/20 ; lens used 18. Hearing: A. D. 15/15 A. S. 15/15 14. Urine examination: Color Pale Reaction Geid elightly Specific gravity 1,021 Albumen Name Casts have Leucocytes Name Sugar None 15. Do you recommend applicant for: (a) General hospital service yes H (b) Tropical service yes - 16. Fill in name and number of base hospital, unit or detachment with which applicant is connected: Army base hospital - Naval base hospital Emergency detachment Navy detachment - Hospital unit Two uilto Haward Tury ahut #22 Genthorfut. BEFT hav demolotized blas. et, Harmafarel M. D. 9 Date lee 27-1919 Address Adamoutto ntH All questions MUST be answered; otherwise certificate will not be accepted at headquarters. To be forwarded to Chief Nurse of Unit or to the Local Committee Organizing Detachment on Red Cross Nursing Service. (SEE OTHER SIDE)

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    "ocrText": "M R 29-N.E.D.\nTHE AMERICAN RED CROSS\nDEPARTMENT OF NURSING\n1sto\n*\nPhysical Examination\n1. Name of applicant Helen was Boylston\nAddress 39Plearant ft City Pathmouth State N.H.\n2. Age\n35 you.\nHeight\n5'-5\"\nWeight 125 lbe - thiffed\nI\n3. General physique Excellent\n4. inherited otherwise None\nTendency to disease, or\n- to\n5. Previous history in regard to serious illness or surgical operation Typhid 1908\nappendictomy 1913\nHe\ndelli\nsu\n6. Has she had rheumatism? the n som avio\n0\n7. has the\n6m\n016\ndedor\na\nHas she at present or she ever had hernia?\n8. Condition of teeth Excellent\n55.\n9. Condition of feet Eveellent\n.0\n10. Abdomen and contained organs Normal\navalo\n.11\n11. Chest and contained organs Normal\nGirth; expiration\n29\"\ninches; inspiration\n32\ninches\nRespiration, of 20 Heart, pulse rate 84\nrate\nRight eye (Snellen) 20/30 ; corrected to 20/20 ;\nlens used\n12. Vision:\nLeft eye (Snellen) 20/20\n;\ncorreeted to\n20/20\n; lens used\n18. Hearing: A. D.\n15/15\nA. S.\n15/15\n14. Urine examination:\nColor Pale\nReaction\nGeid elightly\nSpecific gravity 1,021\nAlbumen Name\nCasts have\nLeucocytes Name\nSugar None\n15. Do you recommend applicant for:\n(a) General hospital service yes\nH\n(b) Tropical service yes\n-\n16. Fill in name and number of base hospital, unit or detachment with which applicant is connected:\nArmy base hospital -\nNaval base hospital\nEmergency detachment\nNavy detachment -\nHospital unit Two uilto Haward Tury ahut #22 Genthorfut. BEFT\nhav demolotized\nblas. et, Harmafarel M. D.\n9\nDate lee 27-1919\nAddress Adamoutto ntH\nAll questions MUST be answered; otherwise certificate will not be accepted at\nheadquarters.\nTo be forwarded to Chief Nurse of Unit or to the Local Committee Organizing\nDetachment on Red Cross Nursing Service.\n(SEE OTHER SIDE)"
}