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AMERICAN RED CROSS NURSING SERVICE
PHYSICAL EXAMINATION
1911
K
&
148 Honora It
1. Name of Applicant,
2. Age 38
Many Height in Weight
Gifiday
135.
M
4. 3. General Are appearance living? sheatly
rs,
your parente
5. If not, at what age of what disease did each die?
M
6. Tendency to disease, inherited or otherwise? None
7. Previous history in regard to serious illness or surgical operation 19 03
D
9
8. Have you had rheumatism ?
N/A
5
9. Have at or have ever had hernia ?
you present you He
&
First class
S
10. Condition of teeth
11. Condition of feet
1,
12. Abdomen and contained organs
Normal.
13. Chest and contained organs
"
Expiration
34 inches.
Inspiration
361/2 inches.
14.
Vision : O.D. 20/20
Hearing A.D. Formals.
:
O. S.
2%/20
-
A.S. Normal.
15. Urine Examination :
Color Center
Reaction acid
Specific Gravity
1020
Albumen about
Casts
Alne
Leucocytes "
Sugar
None
16. Remarks as to fitness of applicant for :
(a) General hospital service Physically qualified 2 experienced.
(b) Tropical service
/!!
trudby Highechmi
M. D.
Date Allarch 3 4/17
Address. 317 Mami Al
Springfill Mass.
To be forwarded by the mursey with duplicate Certificate of Immunity, to Chairman National Committee on
Nursing Service, American Red Cross, Washington, D C.
MAR 16 1917
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"ocrText": "I\nAMERICAN RED CROSS NURSING SERVICE\nPHYSICAL EXAMINATION\n1911\nK\n&\n148 Honora It\n1. Name of Applicant,\n2. Age 38\nMany Height in Weight\nGifiday\n135.\nM\n4. 3. General Are appearance living? sheatly\nrs,\nyour parente\n5. If not, at what age of what disease did each die?\nM\n6. Tendency to disease, inherited or otherwise? None\n7. Previous history in regard to serious illness or surgical operation 19 03\nD\n9\n8. Have you had rheumatism ?\nN/A\n5\n9. Have at or have ever had hernia ?\nyou present you He\n&\nFirst class\nS\n10. Condition of teeth\n11. Condition of feet\n1,\n12. Abdomen and contained organs\nNormal.\n13. Chest and contained organs\n\"\nExpiration\n34 inches.\nInspiration\n361/2 inches.\n14.\nVision : O.D. 20/20\nHearing A.D. Formals.\n:\nO. S.\n2%/20\n-\nA.S. Normal.\n15. Urine Examination :\nColor Center\nReaction acid\nSpecific Gravity\n1020\nAlbumen about\nCasts\nAlne\nLeucocytes \"\nSugar\nNone\n16. Remarks as to fitness of applicant for :\n(a) General hospital service Physically qualified 2 experienced.\n(b) Tropical service\n/!!\ntrudby Highechmi\nM. D.\nDate Allarch 3 4/17\nAddress. 317 Mami Al\nSpringfill Mass.\nTo be forwarded by the mursey with duplicate Certificate of Immunity, to Chairman National Committee on\nNursing Service, American Red Cross, Washington, D C.\nMAR 16 1917"
}