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DMR Form.No. 29 THE AMERICAN RED CROSS CENTRAL DIVISION HEADQUARTERS 180 NORTH WABASH AVENUE CHICAGO, ILL. NURSING SERVICE PHYSICAL EXAMINATION 1. Name of applicant Katherins Popkes Address 138 Waterst St City Walulao State drug 2. Age 28 Height 5-5 Weight 200 3. General physique Healthy Robust 10 lle clashing 4. Tendency to disease, inherited or otherwise none 5. Previous history in regard to serious illness or surgical operation none eccept Ty phvid Fever no 3 years ago 6. Has she had rheumatism? 7. Has she at present or has she ever had hernia? no 8. Condition of teeth, m eyes Good I no > filling Jeeth message (4) god 9. Condition of feet Timelers deterupted. 10. Abdomen and contained organs negative 11. Chest and contained organs togation Expiration 38 inches. Inspiration 42 inches. 12. Vision: O.D. 20/20 Hearing: A.D. 15/10 ft O. S 20/20 A. S. 13/12 ft NOTE: In case of refractive error state degree of correction by glasses. 13. Urine examination: Color Shaw Reaction acid Specific gravity 1016 Albumen none Casts none Leucocytes non Sugar none 14. Do you recommend applicant for: B (a) General hospital service yes no (b) Tropical service 15. Fill in location of base hospital, unit or detachment with which service is desired: Army base hospital at Brefers Foreign service Naval base hospital at Emergency detachment at Navy detachment at L Hospital unit at Surgical section at E sneefe M. D. E.S. Date II questions MUST be answered; otherwise certificate will not be accepted at headquarters. To be forwarded to Chief Nurse of Unit or to Committee Organizing Detachment. Req. 17-833-1-3-18-20M

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    "ocrText": "DMR Form.No. 29\nTHE AMERICAN RED CROSS\nCENTRAL DIVISION HEADQUARTERS\n180 NORTH WABASH AVENUE\nCHICAGO, ILL.\nNURSING SERVICE\nPHYSICAL EXAMINATION\n1. Name of applicant Katherins Popkes\nAddress 138 Waterst St City Walulao State drug\n2. Age\n28\nHeight\n5-5\nWeight 200\n3.\nGeneral physique Healthy Robust 10 lle clashing\n4. Tendency to disease, inherited or otherwise\nnone\n5. Previous history in regard to serious illness or surgical operation none eccept\nTy phvid Fever no 3 years ago\n6. Has she had rheumatism?\n7. Has she at present or has she ever had hernia? no\n8. Condition of teeth, m eyes Good I no > filling Jeeth message (4) god\n9. Condition of feet\nTimelers deterupted.\n10. Abdomen and contained organs\nnegative\n11. Chest and contained organs\ntogation\nExpiration\n38\ninches.\nInspiration\n42\ninches.\n12. Vision: O.D.\n20/20\nHearing: A.D.\n15/10 ft\nO. S\n20/20\nA. S.\n13/12 ft\nNOTE: In case of refractive error state degree of correction by glasses.\n13. Urine examination:\nColor\nShaw\nReaction\nacid\nSpecific gravity\n1016\nAlbumen\nnone\nCasts\nnone\nLeucocytes\nnon\nSugar\nnone\n14. Do you recommend applicant for:\nB\n(a) General hospital service\nyes\nno\n(b) Tropical service\n15. Fill in location of base hospital, unit or detachment with which service is desired:\nArmy base hospital at\nBrefers Foreign service\nNaval base hospital at\nEmergency detachment at\nNavy detachment at\nL\nHospital unit at\nSurgical section at\nE sneefe M. D. E.S.\nDate\nII questions MUST be answered; otherwise certificate will not be accepted at headquarters.\nTo be forwarded to Chief Nurse of Unit or to Committee Organizing Detachment.\nReq. 17-833-1-3-18-20M"
}