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as
B. If a wife, is she now pregnant?
at
50
B
,BOY
11
and
XI. Has the applicant ever had-
XI.
M
A. Rheumatism, acute or chronic?
A mo
an
?.
B. Malaria?
B no
P
C. Other fever?
C
no
F
D. Any disease or injury not included in pre-
D undrew diseases
FRANCIS
F
ceding questions ?
XII. Has the applicant noticed any recent marked
XII.
no
gain or loss in flesh ?
a
XIII. Would you recommend the applicant to a
XIII.
?
reputable Life Insurance Company as a pru-
dent risk
XIV. Do you professionally consider the applicant
XIV.
Doubtful on account
a suitable person, physically, for appointment
to overseas work
t discharging Ear.
XV. Would a tropical climate be likely to induce
XV.
no
disease or cause disablement?
XVI. Are there any facts known to you, or dis-
XVI. no
covered by you, not brought out in the above
questions, affecting or likely to affect the
3
health of the applicant? If so, please state
Is
them.
XVII. Is there, in general, a soundness of constitu-
XVII. Douctful on Gearrel
tion and a vigor of health which give reason-
able probability that the applicant can endure
t are
the physical and mental strain of overseas
work?
XVIII. When was the applicant last successfully
XVIII. 1914
vaccinated?
XIX. Has the applicant had typhoid fever or the
XIX.
no
anti-typhoid inoculation?
NOTE D
Before final credentials are issued to any person enrolled for foreign service for the American Red Cross, a
certificate or certificates must be furnished of vaccination and inoculation against smallpox, typhoid and para-
typhoid fever, or in lieu thereof, a certificate by a physician, approved by the Medical Adviser of the Division
receiving the application, that such person has recently suffered from the disease for the prevention of which there
has been no immunization by vaccination or preventive inoculation.
5
Signature of Medical Examiner.
Helen Walcides M. D.
5
Address
h.4. Hospital
W
of
Page data
- Page
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- Source index
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- Type
- photo
- Media ID
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Document data
- ID
- 2661227
- Core
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- Type
- document
DTO data
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