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AMERICAN RED CROSS NURSING SERVICE
PHYSICAL EXAMINATION
1. Name of Applicant,
Ella V leoguard
2. Age
40
Height 5/14/4/99 Weight
132
3. General appearance
Healthy
4. Are your parents living ?
yes
5. If not, at what age and of what disease did each die?
+
6. Tendency to disease, inherited or otherwise ?
none
7. Previous history in regard to serious illness or surgical operation -
none
8. no
Have you had rheumatism ?
9. no
Have you at present or have you ever had hernia ?
10. Condition of teeth
Viry Good
11. Condition of feet
good
12. Abdomen and contained organs
normal + healthy
13. Chest and contained organs
normal + healthy
Expiration
35%
inches.
Inspiration
32%
inches.
14. Vision : O.D. + 4.eyl all 110 = 6/g Hearing: A.D. 20/20
O. S. + 175D Sph = +450 celanco = 6/8 S.
n/20
15. Urine Examination :
Color
Straw
Reaction
acid
1024
sand
Specific Gravity
Albumen
Casts
more
Leucocytes
none
Sugar
none
16. Remarks as to fitness of applicant for :
(a) General hospital service Thorougday funcified
San
(b) Tropical service
Honoropy questified
M.D.
Date Die 14th MY
Address Filth Rock ank
To be forwarded by the nurse, with duplicate Certificate of Immunity, to Chairman National Committee on
Nursing Service, American Red Cross, Washington, D C.
Vision pow freth certify the rure signite
latire
not
know
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Document data
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"ocrText": "AMERICAN RED CROSS NURSING SERVICE\nPHYSICAL EXAMINATION\n1. Name of Applicant,\nElla V leoguard\n2. Age\n40\nHeight 5/14/4/99 Weight\n132\n3. General appearance\nHealthy\n4. Are your parents living ?\nyes\n5. If not, at what age and of what disease did each die?\n+\n6. Tendency to disease, inherited or otherwise ?\nnone\n7. Previous history in regard to serious illness or surgical operation -\nnone\n8. no\nHave you had rheumatism ?\n9. no\nHave you at present or have you ever had hernia ?\n10. Condition of teeth\nViry Good\n11. Condition of feet\ngood\n12. Abdomen and contained organs\nnormal + healthy\n13. Chest and contained organs\nnormal + healthy\nExpiration\n35%\ninches.\nInspiration\n32%\ninches.\n14. Vision : O.D. + 4.eyl all 110 = 6/g Hearing: A.D. 20/20\nO. S. + 175D Sph = +450 celanco = 6/8 S.\nn/20\n15. Urine Examination :\nColor\nStraw\nReaction\nacid\n1024\nsand\nSpecific Gravity\nAlbumen\nCasts\nmore\nLeucocytes\nnone\nSugar\nnone\n16. Remarks as to fitness of applicant for :\n(a) General hospital service Thorougday funcified\nSan\n(b) Tropical service\nHonoropy questified\nM.D.\nDate Die 14th MY\nAddress Filth Rock ank\nTo be forwarded by the nurse, with duplicate Certificate of Immunity, to Chairman National Committee on\nNursing Service, American Red Cross, Washington, D C.\nVision pow freth certify the rure signite\nlatire\nnot\nknow"
}