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Z ear ar a ter, e J Student Reserve FORM 1193 AMERICAN RED CROSS NURSING SERVICE REV. FEB. 1941 M PHYSICAL EXAMINATION (All questions must be answered by definite statements) 1. Name of applicant June Marjeanne Pushane, Address 308 Hungerford Ave. Nega unee Michigan City State F 2. Age 2I Height 5ft.4s in. I60 +29++7 Weight (feet and inches) (pounds) 3. Family history Negative; no TB, cancer or any other familial diseases. 4. Past history: General health, operation, injury, any illnesses (Indicate dates) Tonsillectomy at age 8; no other serious diseases. 3 5. General physique Healthy robust girl of 21. (Rt. eye 20/50 (Rt. 20/2 Evidence of disease (Lt. eye 20/50 (Lt. 20/20) the (Rt 6. Distant Vision: Without glasses none With glasses none Note: Actual vision should be determined on proper letters for 20 foot distant, as 20-20, 20-30, 20-100, etc. (Rt. ear 20/20 ft.) a the (Rt. none 7. Hearing: (Whispered voice) Evidence of disease (Lt. ea70/20ft. none 8. Teeth and gums: (Note abnormalities) Negative; in good repair. Directions: Indicate as follows- Right Applicant's Left U8 7 6 5 4 3 2 1 Missing tooth Teeth: 1 2 3 4 5 6 7 8 L8 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8 Bridgework Has few fillings throughout teeth. Crown is "Plate"-wr out word to indicate plate. 9. Nose and Throat Negative. 10. Neck: (Thyroid gland and other abnormalities) Negative; no thyroid enlargement. 11. Skeletal: (Bones, joints, muscles and feet) Nor mal; corns and callouses, one on each foot. 18 12. Thorax: Expiration 40 inches Inspiration 43 inches 12 Respiration 20 per minute Lungs to percussion and auscultation Normal Normal Cardio-vascular system Heart: Size Normal Murmurs none 13 Pulse 72 Blood pressure: S II8 D 72 (Over)

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    "ocrText": "Z\near\nar\na\nter,\ne\nJ\nStudent Reserve\nFORM 1193\nAMERICAN RED CROSS NURSING SERVICE\nREV. FEB. 1941\nM\nPHYSICAL EXAMINATION\n(All questions must be answered by definite statements)\n1. Name of applicant\nJune Marjeanne Pushane,\nAddress\n308 Hungerford Ave.\nNega unee\nMichigan\nCity\nState\nF\n2. Age 2I\nHeight\n5ft.4s in.\nI60\n+29++7\nWeight\n(feet and inches)\n(pounds)\n3. Family history Negative; no TB, cancer or any other familial diseases.\n4. Past history: General health, operation, injury, any illnesses (Indicate dates)\nTonsillectomy at age 8;\nno other serious diseases.\n3\n5. General physique Healthy robust girl of 21.\n(Rt. eye 20/50\n(Rt. 20/2\nEvidence of disease\n(Lt. eye 20/50\n(Lt. 20/20)\nthe\n(Rt\n6. Distant Vision: Without glasses\nnone\nWith glasses\nnone\nNote: Actual vision should be determined on proper letters for 20 foot distant, as 20-20, 20-30, 20-100, etc.\n(Rt. ear 20/20 ft.)\na\nthe\n(Rt.\nnone\n7. Hearing: (Whispered voice)\nEvidence of disease\n(Lt. ea70/20ft.\nnone\n8. Teeth and gums: (Note abnormalities)\nNegative; in good repair.\nDirections: Indicate as follows-\nRight\nApplicant's\nLeft\nU8 7 6 5 4 3 2 1\nMissing tooth\nTeeth:\n1\n2 3 4 5 6 7 8\nL8 7 6 5 4 3 2 1\n1 2 3 4 5 6 7 8\nBridgework\nHas few fillings throughout teeth.\nCrown\nis\n\"Plate\"-wr out word to indicate plate.\n9. Nose and Throat Negative.\n10. Neck: (Thyroid gland and other abnormalities)\nNegative; no thyroid enlargement.\n11. Skeletal: (Bones, joints, muscles and feet)\nNor mal; corns and callouses, one on each\nfoot.\n18\n12. Thorax: Expiration\n40\ninches\nInspiration 43\ninches\n12\nRespiration\n20\nper minute\nLungs to percussion and auscultation\nNormal\nNormal\nCardio-vascular system\nHeart: Size\nNormal\nMurmurs\nnone\n13\nPulse\n72\nBlood pressure: S\nII8\nD\n72\n(Over)"
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