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D M R Form No. 29 SCOOS NURSIN SERVICE THE 3 WASHINGTON PHYSICAL EXAMINATION I. Name of applicant Dan 7. Butter Address. 188 farm St. 2. Age 49- Height 5ft City Hariford Weight 149 State One 3. General physique 4. Tendency to disease, inherited or otherwise none 5. Previous history in regard to serious illness or surgical operation Typhoid fiver at 24 yrs. of agr. Tousilectormy in 1914. 6. Has she had rheumatism? mild, transitory arthritis no guff kun, 1915 7. Has she at present or has she ever had hernia? 8. Condition of teeth good 9. Condition of feet normal 10. Abdomen and contained organs normal II. Chest and contained organs normal Expiration 37 - inches. Inspiration 39. inches. 12. Vision: O. D myopeia, corrected to 20/20 Hearing: A. D. 20/20 O. S. 11/20 " " 20/20. A.S. 20/20 NOTE: In case of refractive error state degree of correction by glasses. 13. Urine examination: Color amber Reaction acid Specific gravity 1015 Albumen no. Casts. no Leucocytes no no Sugar 14. Do you recommend applicant for: (a) General hospital service. yes (b) Tropical service no He 15. Fill in location of base hospital, unit or detachment with which service is desired: Army base hospital at Naval base hospital at Field service with Red Cross unit in Emergency detachment at Franch Navy detachment at Hospital unit at Surgical section at M. D. Date Address 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-May--20M

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    "ocrText": "D M R Form No. 29\nSCOOS\nNURSIN SERVICE\nTHE\n3\nWASHINGTON\nPHYSICAL EXAMINATION\nI. Name of applicant Dan 7. Butter\nAddress. 188 farm St.\n2. Age 49-\nHeight 5ft\nCity Hariford Weight 149 State One\n3. General physique\n4. Tendency to disease, inherited or otherwise\nnone\n5. Previous history in regard to serious illness or surgical operation Typhoid fiver at 24 yrs. of\nagr. Tousilectormy in 1914.\n6. Has she had rheumatism? mild, transitory arthritis no guff kun, 1915\n7. Has she at present or has she ever had hernia?\n8. Condition of teeth\ngood\n9. Condition of feet\nnormal\n10. Abdomen and contained organs\nnormal\nII. Chest and contained organs\nnormal\nExpiration\n37 -\ninches.\nInspiration\n39.\ninches.\n12. Vision: O. D myopeia, corrected to 20/20 Hearing: A. D.\n20/20\nO. S. 11/20\n\" \" 20/20.\nA.S.\n20/20\nNOTE: In case of refractive error state degree of correction by glasses.\n13. Urine examination:\nColor amber\nReaction\nacid\nSpecific gravity\n1015\nAlbumen\nno.\nCasts.\nno\nLeucocytes\nno\nno\nSugar\n14. Do you recommend applicant for:\n(a) General hospital service.\nyes\n(b) Tropical service\nno\nHe\n15. Fill in location of base hospital, unit or detachment with which service is desired:\nArmy base hospital at\nNaval base hospital at\nField service with Red Cross unit in\nEmergency detachment at Franch\nNavy detachment at\nHospital unit at\nSurgical section at\nM. D.\nDate\nAddress\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-May--20M"
}