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u D M R 29
THE AMERICAN RED CROSS
F
NURSING SERVICE
C
a
Physical Examination
S
I. Name of applicant miss Emma C. Forster
+
Address. Box288
City GantaBarbara State Cal
er,
2. Age 40
Height 5ft2in(62cm) Weight 110 Cortinary Quit)
3. General physique Well built, fairly robert
4. Tendency to disease, inherited or otherwise none.
in
5. Previous in regard to serious illness or
history surgical operation Has typhoed
in
fever 5 gn ago, complete recovery
6. rheumatism? no
Has she had
7. Has she at present or has she ever had hernia? No.
8. Condition of teeth good. 3 lower molars replaced by bridges. 5upper teeth. pirst
C.
9. Condition of feet good
apposed molars 12
IO. Abdomen and contained organs normal.
II. Chest and contained organs. normal
Girth; expiration
31%
inches; inspiration
34
finches
Respiration,
rate of 28 Heart, pulse 80
rate
Right eye (Snellen) 20/20
; corrected to
;
lens used
I2. Vision :
Left eye (Snellen) 20/20 ; corrected to Dewor lens used
13. Hearing: A. D 15/15
A. S 0/15
14. Urine examination :
Color Light amber
Reaction acid
Specific gravity 1.017
Albumen none
Casts none
Leucocytes. none
Sugar none
B
15. Do you recommend applicant for:
(a) General hospital service yes
(b) Tropical service no.
16. Fill in name and number of base hospital, unit or detachment with which applicant is connected: none
Army base hospital
Naval base hospital
2
Emergency detachment
g
Navy detachment
J
Hospital unit
W
Adrandhunkeeh
M. D.
Date august Address Santa Barbara 438 Cal
of
All questions MUST be answered; otherwise certificate will not be accepted at head=
quarters.
To be forwarded to Chief_Nurse of Unit or to Committee Organizing Detachment.
Req.17-2125B-20M-N
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"ocrText": "u D M R 29\nTHE AMERICAN RED CROSS\nF\nNURSING SERVICE\nC\na\nPhysical Examination\nS\nI. Name of applicant miss Emma C. Forster\n+\nAddress. Box288\nCity GantaBarbara State Cal\ner,\n2. Age 40\nHeight 5ft2in(62cm) Weight 110 Cortinary Quit)\n3. General physique Well built, fairly robert\n4. Tendency to disease, inherited or otherwise none.\nin\n5. Previous in regard to serious illness or\nhistory surgical operation Has typhoed\nin\nfever 5 gn ago, complete recovery\n6. rheumatism? no\nHas she had\n7. Has she at present or has she ever had hernia? No.\n8. Condition of teeth good. 3 lower molars replaced by bridges. 5upper teeth. pirst\nC.\n9. Condition of feet good\napposed molars 12\nIO. Abdomen and contained organs normal.\nII. Chest and contained organs. normal\nGirth; expiration\n31%\ninches; inspiration\n34\nfinches\nRespiration,\nrate of 28 Heart, pulse 80\nrate\nRight eye (Snellen) 20/20\n; corrected to\n;\nlens used\nI2. Vision :\nLeft eye (Snellen) 20/20 ; corrected to Dewor lens used\n13. Hearing: A. D 15/15\nA. S 0/15\n14. Urine examination :\nColor Light amber\nReaction acid\nSpecific gravity 1.017\nAlbumen none\nCasts none\nLeucocytes. none\nSugar none\nB\n15. Do you recommend applicant for:\n(a) General hospital service yes\n(b) Tropical service no.\n16. Fill in name and number of base hospital, unit or detachment with which applicant is connected: none\nArmy base hospital\nNaval base hospital\n2\nEmergency detachment\ng\nNavy detachment\nJ\nHospital unit\nW\nAdrandhunkeeh\nM. D.\nDate august Address Santa Barbara 438 Cal\nof\nAll questions MUST be answered; otherwise certificate will not be accepted at head=\nquarters.\nTo be forwarded to Chief_Nurse of Unit or to Committee Organizing Detachment.\nReq.17-2125B-20M-N"
}