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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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Document data
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- Core
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- Type
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DTO data
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Context sent to Scholar
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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"
}