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XC
D M K 29
THE AMERICAN RED CROSS
NURSING SERVICE
Physical Examination
I. Name of applicant Doia C. Carothers
Address 529 Alass. are City Boston State Mass
2. Age
830
Height 5feet /in Weight 102
3. General physique
Hender
4. or
Tendency to disease, inherited otherwise Noce
5. Previous history in regard to serious illness or surgical operation Typliod 1909
No we 1902 - Exauthernato
6. Has she had rheumatism?
7. Has she at present or has she ever had hernia?
No
8. Condition of teeth
Good
9. Condition of feet
Good
IO. Abdomen and contained organs Normal Negative
II. Chest and contained organs
Girth; expiration
34
inches; inspiration 32
inches
Respiration, rate of
19
Heart, pulse rate
78
Right eye (Snellen)
20/ ; corrected to 2%
; lens used D
,
I2. Vision:
Left eye (Snellen) 20/30/20 ; corrected to. 20/8
of
; lens used
13 Hearing: A. D Normal
A. S
Normal
14. Urine examination
Color
Reaction acid
Specific gravity
1017
Albumen absent
Casts
Noce about found
Leucocytes. Perasional
Sugar
I5. Do you recommend applicant for:
OR
(a)
General hospital service Yes.
(b) Tropical service Cafer
I6. Fill in name and number of base hospital, unit or detachment with which applicant is connected
Army base hospital # 45
Naval base hospital
Emergency detachment
Navy detachment
Hospital unit
CaptaMi.,P.C
levelle R. chadralbs D.
Date
1-25-18
Address 19 Bay State Rd., Boston
All questions MUST be answered; otherwise certificate will not be accepted at head=
quarters.
To be forwarded to Chief Nurse of Unit or to Committee Organizing Detachment w
Req. 17-2125B-20M-Nov.
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"ocrText": "XC\nD M K 29\nTHE AMERICAN RED CROSS\nNURSING SERVICE\nPhysical Examination\nI. Name of applicant Doia C. Carothers\nAddress 529 Alass. are City Boston State Mass\n2. Age\n830\nHeight 5feet /in Weight 102\n3. General physique\nHender\n4. or\nTendency to disease, inherited otherwise Noce\n5. Previous history in regard to serious illness or surgical operation Typliod 1909\nNo we 1902 - Exauthernato\n6. Has she had rheumatism?\n7. Has she at present or has she ever had hernia?\nNo\n8. Condition of teeth\nGood\n9. Condition of feet\nGood\nIO. Abdomen and contained organs Normal Negative\nII. Chest and contained organs\nGirth; expiration\n34\ninches; inspiration 32\ninches\nRespiration, rate of\n19\nHeart, pulse rate\n78\nRight eye (Snellen)\n20/ ; corrected to 2%\n; lens used D\n,\nI2. Vision:\nLeft eye (Snellen) 20/30/20 ; corrected to. 20/8\nof\n; lens used\n13 Hearing: A. D Normal\nA. S\nNormal\n14. Urine examination\nColor\nReaction acid\nSpecific gravity\n1017\nAlbumen absent\nCasts\nNoce about found\nLeucocytes. Perasional\nSugar\nI5. Do you recommend applicant for:\nOR\n(a)\nGeneral hospital service Yes.\n(b) Tropical service Cafer\nI6. Fill in name and number of base hospital, unit or detachment with which applicant is connected\nArmy base hospital # 45\nNaval base hospital\nEmergency detachment\nNavy detachment\nHospital unit\nCaptaMi.,P.C\nlevelle R. chadralbs D.\nDate\n1-25-18\nAddress 19 Bay State Rd., Boston\nAll questions MUST be answered; otherwise certificate will not be accepted at head=\nquarters.\nTo be forwarded to Chief Nurse of Unit or to Committee Organizing Detachment w\nReq. 17-2125B-20M-Nov."
}