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311
REC.
FORM 1193
REV. 10-26-38
AMERICAN RED CROSS NURSING SERVICE
OCT 291940
PHYSICAL EXAMINATION
nemoboA .01
(Follow instructions end of form in answering all questions) nursing
at
1. Name of applicant
Min Phyllis Lou Evans
Address 37 Mansfield
City Everett
State Mass
2. Age
23 years
Height
5'32"
Weight 144 lbs-
3.
Family history essentially negative
4. Past history; General health, operation, injury, any illnesses negative
F
repert for 2 1/2 years ago - mearles
chich fux - mumps
55
5. General physique
so allent
6. Eyes: Pupils; Right eye; Distant vision 20/15 Corrected to
Lens used
Left eye; Distant vision 20/15 Corrected to
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
8. Teeth and gums: (note abnormalities) good
NOTE:-Check chart on other side of blank.
9. Throat
Iomis atrophical ghurst negative
10. and other
Neck: (Thyroid gland abnormalities) negative
11. Skeletal: (Bones, joints, muscles and feet) negative
12. Thorax: Expiration
3.5th
inches
Inspiration 341/2 inches
Respiration
18
per minute
8
Lungs to percussion and auscultation resonant J clear -
Cardio-vascular system
normal
Heart: Size
normal
Murmurs abrent
Pulse
10
Blood pressure: S 125
D 10
(Over)
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"ocrText": "311\nREC.\nFORM 1193\nREV. 10-26-38\nAMERICAN RED CROSS NURSING SERVICE\nOCT 291940\nPHYSICAL EXAMINATION\nnemoboA .01\n(Follow instructions end of form in answering all questions) nursing\nat\n1. Name of applicant\nMin Phyllis Lou Evans\nAddress 37 Mansfield\nCity Everett\nState Mass\n2. Age\n23 years\nHeight\n5'32\"\nWeight 144 lbs-\n3.\nFamily history essentially negative\n4. Past history; General health, operation, injury, any illnesses negative\nF\nrepert for 2 1/2 years ago - mearles\nchich fux - mumps\n55\n5. General physique\nso allent\n6. Eyes: Pupils; Right eye; Distant vision 20/15 Corrected to\nLens used\nLeft eye; Distant vision 20/15 Corrected to\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\n8. Teeth and gums: (note abnormalities) good\nNOTE:-Check chart on other side of blank.\n9. Throat\nIomis atrophical ghurst negative\n10. and other\nNeck: (Thyroid gland abnormalities) negative\n11. Skeletal: (Bones, joints, muscles and feet) negative\n12. Thorax: Expiration\n3.5th\ninches\nInspiration 341/2 inches\nRespiration\n18\nper minute\n8\nLungs to percussion and auscultation resonant J clear -\nCardio-vascular system\nnormal\nHeart: Size\nnormal\nMurmurs abrent\nPulse\n10\nBlood pressure: S 125\nD 10\n(Over)"
}