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FORM 1045
REV. 4-4-38
THE AMERICAN RED CROSS
NATIONAL HEADQUARTERS
WASHINGTON. D. c.
Dear Red Cross Nurse:
The National Committee on Red Cross Nursing Service requires us to submit,
annually, a report of all the Red Cross Nurses enrolled with our Committee. Will you
therefore, please answer the following questions and return this form to me, in the
enclosed envelope, at the earliest possible date? THIS ANNUAL QUESTIONNAIRE IS FILED
WITH YOUR RECORDS AT NATIONAL HEADQUARTERS IN WASHINGTON, D. C. We hope you will rec-
ognize the value of filing this information and will return the questionnaire promptly,
as we are extremely anxious to make a very complete report to National Headquarters.
IMPORTANT:
Yours sincerely,
In order to render prompt service
Chairman or
in time of disaster, enrolled Red Cross
BEATRICE BAIN
Secretary.
Nurses should report at once to the
SUTTER HOSPITAL
Secretary of the Local Committee under
Sacramento, Calif.
Local Committee.
which they are enrolled. Do not forget
the address of the Secretary.
Name in full
agrie g Hansgen
If married, give husband's name
Permanent address Socramments Hospital Socrounts Color
(STREET, ETC.)
(CITY)
(COUNTY)
(STATE)
Probable address for the next year above
(STREET, ETC.)
Telephone No. Cop 4 200.
(CITY)
(COUNTY)
(STATE)
Name and address of nearest relative or friend, in United States, through whom you may
be communicated with in an emergency. (State relationship)
mrs many tracker - 1503 Costino Ookland Sentis
Underline the type of work you are now doing:
Army - Navy - U.S.P.H. Service - Veterans Administration - U.S. Indian Service -
Public Health - Institutional - Private Duty - Industrial - Office Nurse - Registrar.
Are you an instructor of Red Cross classes in Home Hygiene and Care of the Sick?
no.
Have you ever been? no
Would you like to teach Red Cross classes? no
Indicate present physical condition good
Would you respond to an emergency call in event of epidemic, disaster, war, etc.? zr
Badge No. 16137
Current date may 39
NOTE.--If the nurse does not complete and return this questionnaire, and can not be
located within two years, her enrolment will be removed from our active files.

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Document data

ID: 2661468
Core: doc
Type: document

DTO data

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Document identity

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Document source extras

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    "coverageEndDate": {
        "day": 26,
        "logicalDate": "1945-11-26",
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Page context

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    "ocrText": "FORM 1045\nREV. 4-4-38\nTHE AMERICAN RED CROSS\nNATIONAL HEADQUARTERS\nWASHINGTON. D. c.\nDear Red Cross Nurse:\nThe National Committee on Red Cross Nursing Service requires us to submit,\nannually, a report of all the Red Cross Nurses enrolled with our Committee. Will you\ntherefore, please answer the following questions and return this form to me, in the\nenclosed envelope, at the earliest possible date? THIS ANNUAL QUESTIONNAIRE IS FILED\nWITH YOUR RECORDS AT NATIONAL HEADQUARTERS IN WASHINGTON, D. C. We hope you will rec-\nognize the value of filing this information and will return the questionnaire promptly,\nas we are extremely anxious to make a very complete report to National Headquarters.\nIMPORTANT:\nYours sincerely,\nIn order to render prompt service\nChairman or\nin time of disaster, enrolled Red Cross\nBEATRICE BAIN\nSecretary.\nNurses should report at once to the\nSUTTER HOSPITAL\nSecretary of the Local Committee under\nSacramento, Calif.\nLocal Committee.\nwhich they are enrolled. Do not forget\nthe address of the Secretary.\nName in full\nagrie g Hansgen\nIf married, give husband's name\nPermanent address Socramments Hospital Socrounts Color\n(STREET, ETC.)\n(CITY)\n(COUNTY)\n(STATE)\nProbable address for the next year above\n(STREET, ETC.)\nTelephone No. Cop 4 200.\n(CITY)\n(COUNTY)\n(STATE)\nName and address of nearest relative or friend, in United States, through whom you may\nbe communicated with in an emergency. (State relationship)\nmrs many tracker - 1503 Costino Ookland Sentis\nUnderline the type of work you are now doing:\nArmy - Navy - U.S.P.H. Service - Veterans Administration - U.S. Indian Service -\nPublic Health - Institutional - Private Duty - Industrial - Office Nurse - Registrar.\nAre you an instructor of Red Cross classes in Home Hygiene and Care of the Sick?\nno.\nHave you ever been? no\nWould you like to teach Red Cross classes? no\nIndicate present physical condition good\nWould you respond to an emergency call in event of epidemic, disaster, war, etc.? zr\nBadge No. 16137\nCurrent date may 39\nNOTE.--If the nurse does not complete and return this questionnaire, and can not be\nlocated within two years, her enrolment will be removed from our active files."
}

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