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HZH154 3 Form 596 AMERICAN RED CROSS Bureau of Nursing Service Broaklyn N. y at (City and State - which examined) ATLANTIC DIVIDION 44 EAST 28RD ST. mach 2/1919 NEW YORK CITY DIVISION. gar N Confidential Report of Medical Examiner In the case of magant ay Address 176 Rogers line. B Heyn s.z % Sevediah Vaspital. Questions to be Answered by Examining Physician. Note 1. Personnel in the foreign service of the American Red Cross often live and work in such trying climates, to amid loneliness such insanitary surroundings, exposed to such malignant diseases, and under such a health nervous should strain be incident recommended for ap- and expatriation, It is therefore that only expected that the Medical Examiner will make the examination thorough and circumstantial will be men and women of sound constitution and vigorous placed by the American Red Cross. Every question should be answered as omissions will necessitate correspondence pointment. and that he will feel the responsibility of his office, bearing in mind that upon his statements great reliance Note 2. The examiner will please ask questions calculated to bring out the various symptoms pointing to the several probability diseases as to the reasons. under each head, fully state any injurious effects of previous illness or injury and give an opinion as to the of its recurrence in the less favorable conditions under which the applicant is to work. I. A. What is the applicant's age? I. A 27 years B. Have you had previous acquaintance with the applicant? How long? B yes 10 months C. Have you treated him or her professionally ? C. no. For what disease or injury? D. Does the general appearance indicate vigor- D. General affance good ous, medium or delicate health? E. State weight. E 135 found 5' 4" Height. Figure. F no. F. Is there any deformity or malformation? G. What is the temperament, nervous or other- G Good wise? II. The Respiratory System. II. A yes to fer. A. Is the respiration full, easy and regular? State the number of respirations in a minute. B. Is there any tendency to cough, expectoration B none or difficulty in breathing? C. Does the physical examination reveal anything C BY whatever abnormal in the condition of the respiratory organs? If yes, explain fully and state your opinion as to its significance. 2 4 r

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    "ocrText": "HZH154\n3\nForm 596\nAMERICAN RED\nCROSS Bureau of Nursing Service\nBroaklyn N. y\nat\n(City and State - which examined)\nATLANTIC DIVIDION\n44 EAST 28RD ST.\nmach 2/1919\nNEW YORK CITY\nDIVISION.\ngar\nN\nConfidential Report of Medical Examiner\nIn the case of magant ay\nAddress 176 Rogers line. B Heyn s.z % Sevediah Vaspital.\nQuestions to be Answered by Examining Physician.\nNote 1. Personnel in the foreign service of the American Red Cross often live and work in such trying climates, to amid loneliness such\ninsanitary surroundings, exposed to such malignant diseases, and under such a health nervous should strain be incident recommended for ap-\nand expatriation, It is therefore that only expected that the Medical Examiner will make the examination thorough and circumstantial will be\nmen\nand\nwomen\nof\nsound\nconstitution\nand\nvigorous\nplaced by the American Red Cross. Every question should be answered as omissions will necessitate correspondence\npointment. and that he will feel the responsibility of his office, bearing in mind that upon his statements great reliance\nNote 2. The examiner will please ask questions calculated to bring out the various symptoms pointing to the several probability diseases\nas to the reasons.\nunder each head, fully state any injurious effects of previous illness or injury and give an opinion as to the\nof its recurrence in the less favorable conditions under which the applicant is to work.\nI. A. What is the applicant's age?\nI. A\n27 years\nB. Have you had previous acquaintance with the\napplicant? How long?\nB yes\n10 months\nC. Have you treated him or her professionally ?\nC. no.\nFor what disease or injury?\nD. Does the general appearance indicate vigor-\nD. General affance good\nous, medium or delicate health?\nE. State weight.\nE\n135 found\n5' 4\"\nHeight.\nFigure.\nF no.\nF. Is there any deformity or malformation?\nG. What is the temperament, nervous or other-\nG Good\nwise?\nII. The Respiratory System.\nII. A yes to fer.\nA. Is the respiration full, easy and regular? State\nthe number of respirations in a minute.\nB. Is there any tendency to cough, expectoration\nB none\nor difficulty in breathing?\nC. Does the physical examination reveal anything\nC\nBY\nwhatever abnormal in the condition of the\nrespiratory organs? If yes, explain fully\nand state your opinion as to its significance.\n2\n4\nr"
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