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I
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THE AMERICAN RED CROSS NURSING SERVICE
FORM 1193
REV. 11-26-34
BAWER
CARROLL
CASE
N
PHYSICAL EXAMINATION
GILLETTE
HAIG
MC ALLISTER
MC COY
MOORE
RICHARBSON
(Follow instructions at end of form in answering all questions)
1. Name of applicant Frances Salrum
READ SMITH WEBER
FILES
M
City San Francisa State Calif
TS,
Address 2340
F
2. Age 22
Height 5:14
Weight 131
1
N
3. General physique good
(b
-
4. Tendency to disease, inherited or otherwise none
-
B
5. Previous history in regard illness injury Scarled fever 1-9-36
to or
malletmath
IFB/img
conjection reading no
Vision: Right eye; Distant vision 20/15 Corrected to
only for distance glassibed
Lens used +25
Left eye; Distant vision 20/15 Corrected to
Lens used +50+25x90°
Note:-Actual vision should be determined on proper letters for 20 foot distant,
as 20-20,20-30,20-100,etc. If glasses are worn state correction.
Date 6/15/37
J w Bettman M.D.
NOTE-Check chart on other side of blank.
9. Neck: (Thyroid glands and other abnormalities) no abnormatics
10. Spine and extremities: (bones, joints, muscles and feet) negative
11.
Thorax: Respiratory system, bronchi, lungs, pleura, etc negation
Expiration
30
inches
Inspiration 351/
inches
Respiration
18
per minute
Cardio-vascular system negative
Heart:
(note all signs of cardiac involvement) negative
Pulse 78 Blood pressure: S 108 D. 62
(Over)
2
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"ocrText": "ZI\nee\na\nto\nar\nI\nE\nTHE AMERICAN RED CROSS NURSING SERVICE\nFORM 1193\nREV. 11-26-34\nBAWER\nCARROLL\nCASE\nN\nPHYSICAL EXAMINATION\nGILLETTE\nHAIG\nMC ALLISTER\nMC COY\nMOORE\nRICHARBSON\n(Follow instructions at end of form in answering all questions)\n1. Name of applicant Frances Salrum\nREAD SMITH WEBER\nFILES\nM\nCity San Francisa State Calif\nTS,\nAddress 2340\nF\n2. Age 22\nHeight 5:14\nWeight 131\n1\nN\n3. General physique good\n(b\n-\n4. Tendency to disease, inherited or otherwise none\n-\nB\n5. Previous history in regard illness injury Scarled fever 1-9-36\nto or\nmalletmath\nIFB/img\nconjection reading no\nVision: Right eye; Distant vision 20/15 Corrected to\nonly for distance glassibed\nLens used +25\nLeft eye; Distant vision 20/15 Corrected to\nLens used +50+25x90°\nNote:-Actual vision should be determined on proper letters for 20 foot distant,\nas 20-20,20-30,20-100,etc. If glasses are worn state correction.\nDate 6/15/37\nJ w Bettman M.D.\nNOTE-Check chart on other side of blank.\n9. Neck: (Thyroid glands and other abnormalities) no abnormatics\n10. Spine and extremities: (bones, joints, muscles and feet) negative\n11.\nThorax: Respiratory system, bronchi, lungs, pleura, etc negation\nExpiration\n30\ninches\nInspiration 351/\ninches\nRespiration\n18\nper minute\nCardio-vascular system negative\nHeart:\n(note all signs of cardiac involvement) negative\nPulse 78 Blood pressure: S 108 D. 62\n(Over)\n2"
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