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FORM 1193
AMERICAN RED CROSS NURSING SERVICE
REV. 10-26-38
PHYSICAL EXAMINATION
(Follow instructions at end of form in answering all questions)
1. Name of applicant many Louise Carpenter
Revise Rdd City Winchester
State mess
2. Age
28
Height 5'21"
Weight 124 #
3.
Family history motherhod tuberculories before birth of
abblient - but was allested case. Father has
4. Past history: General health, operation, injury, any illnesses
0
5. General physique Well der r nourished
Scarletfrus 10 years. appe destiny @23, TrA e l2
6. vision 20/40 Corrected to 20/30 Lens used +75-50-15
Eyes: Pupils; Right eye; Distant
Left eye; Distant vision 20/202 Corrected to 20/15 Lens used +1.00-25x180
NOTE:-Actual vision should be determined on proper letters for 20 foot distant, as 20-20, 20-30, 20-100, etc.
If glasses are worn state correction.
7. Ears: whisper 25 20 an
8. Teeth and gums: (note abnormalities)
good
ar.
NOTE:-Check chart on other side of blank.
9. Throat
normal
10. Neck: (Thyroid gland and other abnormalities)
hormal
11. Skeletal: (Bones, joints, muscles and feet)
Fromal
12. Thorax: Expiration
28
inches
Inspiration
32 inches
Respiration 18
per minute
Lungs to percussion and auscultation animal
8
Cardio-vascular system Troused
U
Heart: Size hand
5
3
Murmurs 0
8
Pulse 85
Blood S 120
pressure:
D 70
(Over)
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"ocrText": "FORM 1193\nAMERICAN RED CROSS NURSING SERVICE\nREV. 10-26-38\nPHYSICAL EXAMINATION\n(Follow instructions at end of form in answering all questions)\n1. Name of applicant many Louise Carpenter\nRevise Rdd City Winchester\nState mess\n2. Age\n28\nHeight 5'21\"\nWeight 124 #\n3.\nFamily history motherhod tuberculories before birth of\nabblient - but was allested case. Father has\n4. Past history: General health, operation, injury, any illnesses\n0\n5. General physique Well der r nourished\nScarletfrus 10 years. appe destiny @23, TrA e l2\n6. vision 20/40 Corrected to 20/30 Lens used +75-50-15\nEyes: Pupils; Right eye; Distant\nLeft eye; Distant vision 20/202 Corrected to 20/15 Lens used +1.00-25x180\nNOTE:-Actual vision should be determined on proper letters for 20 foot distant, as 20-20, 20-30, 20-100, etc.\nIf glasses are worn state correction.\n7. Ears: whisper 25 20 an\n8. Teeth and gums: (note abnormalities)\ngood\nar.\nNOTE:-Check chart on other side of blank.\n9. Throat\nnormal\n10. Neck: (Thyroid gland and other abnormalities)\nhormal\n11. Skeletal: (Bones, joints, muscles and feet)\nFromal\n12. Thorax: Expiration\n28\ninches\nInspiration\n32 inches\nRespiration 18\nper minute\nLungs to percussion and auscultation animal\n8\nCardio-vascular system Troused\nU\nHeart: Size hand\n5\n3\nMurmurs 0\n8\nPulse 85\nBlood S 120\npressure:\nD 70\n(Over)"
}