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N
F
et,
Form 1193
Rev. 6-15-25
THE AMERICAN RED CROSS NURSING SERVICE
E
-
PHYSICAL EXAMINATION
Mr
(Follow instructions at foot of page in answering all questions)
its
(A
1. Name of applicant Languies, Elizabeth Jeanute Badge No.
2. Age 21
Address Tabire Has pital 5.5" City Okkland State Calif.
eth
E
Height
Weight 127th
3. General physique Wee developed mounshed
4. Tendency to disease, inherited or otherwise
un
5. Previous history in regard to serious illness or surgical_operation
chishand desease.
6. Has she had rheumatism ?
us -
7. Has she at present or has she ever had hernia ?
no
PB
8. Condition of teeth good none and fallings -good byjum
J.
9. Condition of Bones and Joints good
Flat Foot Mo
10.
11. Chest and contained organs hungs clear- regular no murmus
Abdomen and contained organs Us tranderness , up nove
Girth: Expiration
3 2 12
inches. Inspiration 34 12
inches
techniques
24
88
E
J
Respiration, rate of
Heart, pulse rate
Right eye
(Snellen) 2020 Corrected to N/O lens used + 50
12. Vision:
Left eye (Snellen)
20/00
Corrected to
w
WO
lens used +50
NOTE.- Actual vision should be stated, determined on proper letters for 20 foot distance, as 20-20, 20-50, 20-100, etc.
If glasses
are worn state correction.
13. Hearing: Right
20-20
Left
220
Hearing should record whispered voice at 20 feet, as 20-20, 15-20, 10-20, etc.
14. Urine examination :
Color
Yellow
Reaction
alk 8 m.R.
Specific gravity
1008
Albumen
absent
Casts
absent
Sugar
abseuh
Leucocytes len than day 4.8.7. ed.ou
triple phange ver.
15. Do you recommend applicant for active hospital service?
you
Hadi M. D.
Date
Oct. 4.1920
Address
All questions MUST be answered; otherwise certificate will not be accepted at Headquarters.
To be forwarded to the Local Committee on Red Cross Nursing Service.
1. Be sure that all items are filled in before forwarding. Make definite statements in all instances.
2. Give age in years, height in inches, weight in pounds, stating amount of clothing entering into weight.
8. State what teeth are missing and existing dentistry, such as crowns, plates, etc. State number of opposed molars.
9. Flat foot-state whether or not any inconvenience exists.
11. Chest measurements should be in total inches.
Page data
- Page
- 22
- Source index
- 0
- Type
- photo
- Media ID
- 780f7d861e500f29
- Size
- unknown
Document data
- ID
- 2661479
- Core
- doc
- Type
- document
DTO data
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Context sent to Scholar
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"ocrText": "N\nF\net,\nForm 1193\nRev. 6-15-25\nTHE AMERICAN RED CROSS NURSING SERVICE\nE\n-\nPHYSICAL EXAMINATION\nMr\n(Follow instructions at foot of page in answering all questions)\nits\n(A\n1. Name of applicant Languies, Elizabeth Jeanute Badge No.\n2. Age 21\nAddress Tabire Has pital 5.5\" City Okkland State Calif.\neth\nE\nHeight\nWeight 127th\n3. General physique Wee developed mounshed\n4. Tendency to disease, inherited or otherwise\nun\n5. Previous history in regard to serious illness or surgical_operation\nchishand desease.\n6. Has she had rheumatism ?\nus -\n7. Has she at present or has she ever had hernia ?\nno\nPB\n8. Condition of teeth good none and fallings -good byjum\nJ.\n9. Condition of Bones and Joints good\nFlat Foot Mo\n10.\n11. Chest and contained organs hungs clear- regular no murmus\nAbdomen and contained organs Us tranderness , up nove\nGirth: Expiration\n3 2 12\ninches. Inspiration 34 12\ninches\ntechniques\n24\n88\nE\nJ\nRespiration, rate of\nHeart, pulse rate\nRight eye\n(Snellen) 2020 Corrected to N/O lens used + 50\n12. Vision:\nLeft eye (Snellen)\n20/00\nCorrected to\nw\nWO\nlens used +50\nNOTE.- Actual vision should be stated, determined on proper letters for 20 foot distance, as 20-20, 20-50, 20-100, etc.\nIf glasses\nare worn state correction.\n13. Hearing: Right\n20-20\nLeft\n220\nHearing should record whispered voice at 20 feet, as 20-20, 15-20, 10-20, etc.\n14. Urine examination :\nColor\nYellow\nReaction\nalk 8 m.R.\nSpecific gravity\n1008\nAlbumen\nabsent\nCasts\nabsent\nSugar\nabseuh\nLeucocytes len than day 4.8.7. ed.ou\ntriple phange ver.\n15. Do you recommend applicant for active hospital service?\nyou\nHadi M. D.\nDate\nOct. 4.1920\nAddress\nAll questions MUST be answered; otherwise certificate will not be accepted at Headquarters.\nTo be forwarded to the Local Committee on Red Cross Nursing Service.\n1. Be sure that all items are filled in before forwarding. Make definite statements in all instances.\n2. Give age in years, height in inches, weight in pounds, stating amount of clothing entering into weight.\n8. State what teeth are missing and existing dentistry, such as crowns, plates, etc. State number of opposed molars.\n9. Flat foot-state whether or not any inconvenience exists.\n11. Chest measurements should be in total inches."
}