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HARVARD UNIT
FORM 1193
AMERICAN RED CROSS NURSING SERVICE
REV. 10-26-38
34520
PHYSICAL - EXAMINATION
(Follow instructions at end of form in answering all questions)
1. Name of applicant
many Louise Conpenter
Address Mass General Hospitalogs Boston
State Mars
2. Age
29
Height 5'3'"
Weight 120
3. Family history
mother arrestifiBle
4.
Past history: General health, operation, injury, any illnesses appendentary 1935
TIA-1923. Smile fever-11721
5. General physique
Excellent
6. Eyes: Pupils; Right eye; Distant vision 20/00 50 Corrected to 20/130 Lens
+150-75ay30
used
Left eye; Distant vision 20/20 +3 Corrected to 20/20t4 Lens used
+1.50-,50ax14
30
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:
O.K.
8. Teeth and gums: (note abnormalities)
OK - Elje bedgebute
NOTE:-Check chart on other side of blank.
9. Throat
J.K.
10. Neck: (Thyroid gland and other abnormalities) normal
11. Skeletal: (Bones, joints, muscles and feet) normal
12. Thorax: Expiration
33
inches
Inspiration 36
inches
Respiration 20
per minute
clean
Lungs to percussion and auscultation
U
Cardio-vascular system
normal
5
normal
W
Heart: Size
8
Murmurs systitis
Pulse
74
Blood pressure: S 120
$80
(Over)
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"ocrText": "HARVARD UNIT\nFORM 1193\nAMERICAN RED CROSS NURSING SERVICE\nREV. 10-26-38\n34520\nPHYSICAL - EXAMINATION\n(Follow instructions at end of form in answering all questions)\n1. Name of applicant\nmany Louise Conpenter\nAddress Mass General Hospitalogs Boston\nState Mars\n2. Age\n29\nHeight 5'3'\"\nWeight 120\n3. Family history\nmother arrestifiBle\n4.\nPast history: General health, operation, injury, any illnesses appendentary 1935\nTIA-1923. Smile fever-11721\n5. General physique\nExcellent\n6. Eyes: Pupils; Right eye; Distant vision 20/00 50 Corrected to 20/130 Lens\n+150-75ay30\nused\nLeft eye; Distant vision 20/20 +3 Corrected to 20/20t4 Lens used\n+1.50-,50ax14\n30\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:\nO.K.\n8. Teeth and gums: (note abnormalities)\nOK - Elje bedgebute\nNOTE:-Check chart on other side of blank.\n9. Throat\nJ.K.\n10. Neck: (Thyroid gland and other abnormalities) normal\n11. Skeletal: (Bones, joints, muscles and feet) normal\n12. Thorax: Expiration\n33\ninches\nInspiration 36\ninches\nRespiration 20\nper minute\nclean\nLungs to percussion and auscultation\nU\nCardio-vascular system\nnormal\n5\nnormal\nW\nHeart: Size\n8\nMurmurs systitis\nPulse\n74\nBlood pressure: S 120\n$80\n(Over)"
}