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FORM 1193 REV. FEB. 1941 AMERICAN RED CROSS NURSING SERVICE see no reason in PHYSICAL EXAMINATION here adv. conditions # see revised (All questions must be answered by definite statements) sand please 1. Name of applicant. Henrietta Fitch 1/3/42 Address 75 Score St, City moutclair. 2. Age 32 Height (Feet and inches) Weight 112 (pounds) State new Jersey -16 3. Family history 4. Past history: General health, operation, injury, any illnesses (Indicate dates) Good V Chalecystectomy- - 1939- appendectomy - 1930 Jousillestomy 1931. 5. General physique will nourished well developed (Rt. eye 20/201 (Rt. 20/ 6. Distant Vision: Without glasses Lt. eye 20 /20/ With glasses Lt. 20/ } SR. LL. nove Evidence of disease none Note: Actual vision should be determined on proper letters for 20 foot distant, as 20-20, 20-30, 20-100, etc. (Rt. ear 10/20 ft. 7. Hearing: (Whispered voice) Evidence of disease SRt. none (Lt. ear 80/20 ft.) Lt. none 8. Teeth and gums: (Note abnormalities) Directions: Indicate as follows- Right Applicant's Left X U8 Missing tooth Teeth: 7 6 43 1 1 2345678 L8 6 $ 4 3 1 2 1 12345878 Bridgework Crown "Plate"-write out word to indicate plate. 9. Nose and Throat no evidence of disease 10. Neck: (Thyroid gland and other abnormalities) normal 11. Skeletal: (Bones, joints, muscles and feet) 10 proxation g fat 12. Thorax: Expiration 32 inches Inspiration 34 inches Respiration 18 per minute Cardio-vascular system normal Lungs to percussion and auscultation clear throughout Heart: Size normal Murmurs none 13 Pulse 70 : Blood pressure: S 104 D 68 (Over)

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0
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    "ocrText": "FORM 1193\nREV. FEB. 1941\nAMERICAN RED CROSS NURSING SERVICE\nsee no reason in\nPHYSICAL EXAMINATION\nhere adv. conditions #\nsee revised\n(All questions must be answered by definite statements)\nsand please\n1. Name of applicant. Henrietta Fitch\n1/3/42\nAddress 75 Score St,\nCity moutclair.\n2. Age 32\nHeight (Feet and inches) Weight 112 (pounds)\nState new Jersey\n-16\n3. Family history\n4. Past history: General health, operation, injury, any illnesses (Indicate dates) Good\nV Chalecystectomy- - 1939- appendectomy - 1930 Jousillestomy 1931.\n5. General physique will nourished well developed\n(Rt. eye 20/201\n(Rt. 20/\n6. Distant Vision: Without glasses\nLt. eye 20 /20/\nWith glasses\nLt. 20/\n}\nSR. LL.\nnove\nEvidence of disease\nnone\nNote: Actual vision should be determined on proper letters for 20 foot distant, as 20-20, 20-30, 20-100, etc.\n(Rt. ear 10/20 ft.\n7. Hearing: (Whispered voice)\nEvidence of disease\nSRt. none\n(Lt. ear 80/20 ft.)\nLt.\nnone\n8. Teeth and gums: (Note abnormalities)\nDirections: Indicate as follows-\nRight\nApplicant's\nLeft\nX\nU8\nMissing tooth\nTeeth:\n7\n6\n43\n1\n1\n2345678\nL8\n6\n$ 4 3 1 2 1\n12345878\nBridgework\nCrown\n\"Plate\"-write out word to indicate plate.\n9. Nose and Throat\nno evidence of disease\n10. Neck: (Thyroid gland and other abnormalities) normal\n11. Skeletal: (Bones, joints, muscles and feet) 10 proxation g fat\n12. Thorax: Expiration\n32\ninches\nInspiration\n34\ninches\nRespiration\n18\nper minute\nCardio-vascular system normal\nLungs to percussion and auscultation clear throughout\nHeart: Size normal\nMurmurs none\n13\nPulse\n70\n:\nBlood pressure: S 104\nD 68\n(Over)"
}