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FORM 1193
REV. 10-26-38
AMERICAN RED CROSS NURSING SERVICE
E
To
d
PHYSICAL EXAMINATION
(Follow instructions at end of form in answering all questions) Sent in by nurse
1. Name of applicant Edna Cru hely neu considered for France
P.H. nuses new
Address VB CLD City Paw Pan State mich 1940
M
33
Height
5'6" l'
Weight
159
a
2. Age
3. Family history
normal
4. Past history: General health, operation, injury, any illnesses
normal
5. General physique
normal
6. Eyes: Pupils; Right eye; Distant vision 20/20 Corrected to
Left eye; Distant vision 20/20 Corrected to
Lens used none
Lens used
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:
normal
renimax8
8. Teeth and gums: (note abnormalities)
normal
NOTE:-Check chart on other side of blank.
9. Throat normal
10. Neck: (Thyroid gland and other abnormalities)
normal
11. Skeletal: (Bones, joints, muscles and feet)
normal
12. Thorax: Expiration
29
inches
Inspiration
33
inches
Respiration 20
per minute
5
Lungs to percussion and
auscultation normal
a
Cardio-vascular system
normal
3
normal
U
Heart: Size
Murmurs normal
Pulse
78
Blood pressure: S 122 D 84
(Over)
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"ocrText": "FORM 1193\nREV. 10-26-38\nAMERICAN RED CROSS NURSING SERVICE\nE\nTo\nd\nPHYSICAL EXAMINATION\n(Follow instructions at end of form in answering all questions) Sent in by nurse\n1. Name of applicant Edna Cru hely neu considered for France\nP.H. nuses new\nAddress VB CLD City Paw Pan State mich 1940\nM\n33\nHeight\n5'6\" l'\nWeight\n159\na\n2. Age\n3. Family history\nnormal\n4. Past history: General health, operation, injury, any illnesses\nnormal\n5. General physique\nnormal\n6. Eyes: Pupils; Right eye; Distant vision 20/20 Corrected to\nLeft eye; Distant vision 20/20 Corrected to\nLens used none\nLens used\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:\nnormal\nrenimax8\n8. Teeth and gums: (note abnormalities)\nnormal\nNOTE:-Check chart on other side of blank.\n9. Throat normal\n10. Neck: (Thyroid gland and other abnormalities)\nnormal\n11. Skeletal: (Bones, joints, muscles and feet)\nnormal\n12. Thorax: Expiration\n29\ninches\nInspiration\n33\ninches\nRespiration 20\nper minute\n5\nLungs to percussion and\nauscultation normal\na\nCardio-vascular system\nnormal\n3\nnormal\nU\nHeart: Size\nMurmurs normal\nPulse\n78\nBlood pressure: S 122 D 84\n(Over)"
}