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Z I e e ar a 30 37 I E THE AMERICAN RED CROSS NURSING SERVICE C FORM 1193 REV. 11-26-34 O BAWER CARROLL CASE N a PHYSICAL EXAMINATION GILLETTE WAIG MC ALLISTER (Follow instructions at end of form in answering all questions) MC COY MOORE RICHARBSON 1. Name of applicant Frances Salum READ SMITH WEBER FILES Mrs. Address 2340 City San Francisa State Calif 2. Age 22 Height 5:14 Weight 131 F. 1 N 3. General physique good 4. Tendency to disease, inherited or otherwise none B es 5. Previous history in regard to illness or injury Scarlet fever 1-9-36 magletmath a +0.25+0050+ 90 Vision: Right eye; Distant vision Corrected to Lens used LP +0.50+ 0.250 X120 os molalv 19V8 Left eye; Distant vision Corrected to Lens used os nolalv NOTE:-Actual vision should be determined on proper letters for 20 foot distant, as 20-20, 20-30, 20-100, etc. ad bluoda If glasses are worn state correction. ES Hearing: Right ear; Watch. IN normal 1./40" Whispered voice normal 15/15' 58/21/11 Left ear; Watch /40" Whispered voice Teeth and gums: (note abnormalities) In swr condition 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 negation Heart: (note all signs of cardiac involvement) negative 6 Pulse 78 Blood pressure: S. 108 D. 62 8, (Over)

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