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B. of # 13.
D. M. R. FORM NO.29
F
AMERICAN RED CROSS NURSING SERVICE
0
E
2871
e
PHYSICAL EXAMINATION
T
Greginal
+
&
I. Name of applicant miss Alma &. Forester
9
Address
753 wrst Congress st, Ebicago
2. Age.
31
Height 5'6'
Weight
155.
D
General Good
-
3. appearance
4. Tendency to disease, inherited or otherwise have
{
a
5. Previous history in regard to serious illness or surgical operation none
6. Have you had
rheumatism? no
7. Have you at present or have you ever had hernia? no
8. Condition of teeth
good
good -
9. Condition of feet
normal
IO. Abdomen and contained organs
II. Chest and organs
contained normal
Expiration
36
inches.
Inspiration
39
inches.
12. Vision: o. D. normal
normal
Hearing: A. D.
o. S. normal
A.S.
normal
13. Urine examination:
Color
ambre
Reaction acid
Specific gravity
1022
Albumen
negatin
Casts negative
Leucocytes negation
Sugar negatin
14. Remarks as to fitness of applicant for:
(a) General hospital service
Good = girs fur
(b) Tropical service
= yes = for for this
justo
Good
O.K.
L.S.Gatewood
M. D.
Date april 26,1917
CNO
Address 12 So michigan are
Shicago.
u
To be forwarded to the Chairman National Committee on Nursing Service, American Red Cross,
Washington, D. C.
REQ. 16-600-JULY-3M
authur Dean Bwan
Director No. 13 Base Hospital
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"ocrText": "B. of # 13.\nD. M. R. FORM NO.29\nF\nAMERICAN RED CROSS NURSING SERVICE\n0\nE\n2871\ne\nPHYSICAL EXAMINATION\nT\nGreginal\n+\n&\nI. Name of applicant miss Alma &. Forester\n9\nAddress\n753 wrst Congress st, Ebicago\n2. Age.\n31\nHeight 5'6'\nWeight\n155.\nD\nGeneral Good\n-\n3. appearance\n4. Tendency to disease, inherited or otherwise have\n{\na\n5. Previous history in regard to serious illness or surgical operation none\n6. Have you had\nrheumatism? no\n7. Have you at present or have you ever had hernia? no\n8. Condition of teeth\ngood\ngood -\n9. Condition of feet\nnormal\nIO. Abdomen and contained organs\nII. Chest and organs\ncontained normal\nExpiration\n36\ninches.\nInspiration\n39\ninches.\n12. Vision: o. D. normal\nnormal\nHearing: A. D.\no. S. normal\nA.S.\nnormal\n13. Urine examination:\nColor\nambre\nReaction acid\nSpecific gravity\n1022\nAlbumen\nnegatin\nCasts negative\nLeucocytes negation\nSugar negatin\n14. Remarks as to fitness of applicant for:\n(a) General hospital service\nGood = girs fur\n(b) Tropical service\n= yes = for for this\njusto\nGood\nO.K.\nL.S.Gatewood\nM. D.\nDate april 26,1917\nCNO\nAddress 12 So michigan are\nShicago.\nu\nTo be forwarded to the Chairman National Committee on Nursing Service, American Red Cross,\nWashington, D. C.\nREQ. 16-600-JULY-3M\nauthur Dean Bwan\nDirector No. 13 Base Hospital"
}