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Form 1193-Rev. 2-9-22
THE AMERICAN RED CROSS NURSING SERVICE
00
PHYSICAL EXAMINATION
1. Name of applicant CORBIN, HAZEL IAENE
Badge No.
Address 370 seventh ten-
City new york
State new Jank
2. Age 31 years
Height 5
Weight
173 3/4 els.
3. General physique good
4. Tendency to disease, inherited or otherwise
no
5. Previous history in regard to serious illness or surgical operation
none
6. Has she had rheumatism ?
no.
7. Has she at present or has she ever had hernia? no
8. Condition of teeth
Sxcellent.
9. Condition of feet
good
10. Abdomen and contained organs
good
11. Chest and contained organs
good.
Girth: Expiration
inches. Inspiration
inches
Respiration, rate of
20
Heart, pulse rate average. 72 to 80
Right (Snellen)
lens used
Left eye eye (Snellen) wear
Corrected to
Cannot give
12. Vision :
Corrected to
lens used
the detail of
13. Hearing: A. D.
ok.445
A. S. ok 15/15-
This -
14. Urine examination
Color clear. pale
Reaction
acid
Specific gravity
1008
Albumen neg
Casts
none
Leucocytes neg
Sugar
neg.
15. Do you recommend applicant for active hospital service? Ess.
M.
D.
Date Cal
19-1925 Address
All questions MUST be answered; otherwise certificate will not be accepted at Headquarters.
22 East 6986
To be forwarded to the Local Committee on Red Cross Nursing Service.
newsork
1. Be sure that all items are filled in before forwarding. Make definite statements in all instances.
2. Give age in years, height in inches, weight in pounds, stating amount of clothing entering into weight.
8. State what teeth are missing and existing dentistry, such as crowns, plates, etc. State number of opposed molars.
9. Flat foot-state whether or not any inconvenience exists.
11. Chest measurements should be in total inches.
12. Actual vision should be stated, determined on proper letters for 20 foot distance, as 20-20,20-50,20-100. If glasses
are worn state correction. Hearing should record whispered voice at 15 feet, 15-15, 10-15, etc.
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"ocrText": "Form 1193-Rev. 2-9-22\nTHE AMERICAN RED CROSS NURSING SERVICE\n00\nPHYSICAL EXAMINATION\n1. Name of applicant CORBIN, HAZEL IAENE\nBadge No.\nAddress 370 seventh ten-\nCity new york\nState new Jank\n2. Age 31 years\nHeight 5\nWeight\n173 3/4 els.\n3. General physique good\n4. Tendency to disease, inherited or otherwise\nno\n5. Previous history in regard to serious illness or surgical operation\nnone\n6. Has she had rheumatism ?\nno.\n7. Has she at present or has she ever had hernia? no\n8. Condition of teeth\nSxcellent.\n9. Condition of feet\ngood\n10. Abdomen and contained organs\ngood\n11. Chest and contained organs\ngood.\nGirth: Expiration\ninches. Inspiration\ninches\nRespiration, rate of\n20\nHeart, pulse rate average. 72 to 80\nRight (Snellen)\nlens used\nLeft eye eye (Snellen) wear\nCorrected to\nCannot give\n12. Vision :\nCorrected to\nlens used\nthe detail of\n13. Hearing: A. D.\nok.445\nA. S. ok 15/15-\nThis -\n14. Urine examination\nColor clear. pale\nReaction\nacid\nSpecific gravity\n1008\nAlbumen neg\nCasts\nnone\nLeucocytes neg\nSugar\nneg.\n15. Do you recommend applicant for active hospital service? Ess.\nM.\nD.\nDate Cal\n19-1925 Address\nAll questions MUST be answered; otherwise certificate will not be accepted at Headquarters.\n22 East 6986\nTo be forwarded to the Local Committee on Red Cross Nursing Service.\nnewsork\n1. Be sure that all items are filled in before forwarding. Make definite statements in all instances.\n2. Give age in years, height in inches, weight in pounds, stating amount of clothing entering into weight.\n8. State what teeth are missing and existing dentistry, such as crowns, plates, etc. State number of opposed molars.\n9. Flat foot-state whether or not any inconvenience exists.\n11. Chest measurements should be in total inches.\n12. Actual vision should be stated, determined on proper letters for 20 foot distance, as 20-20,20-50,20-100. If glasses\nare worn state correction. Hearing should record whispered voice at 15 feet, 15-15, 10-15, etc."
}