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THE AMERICAN RED CROSS NURSING SERVICE
R
n
FORM 1193
REV. 3-3-34
PHYSICAL EXAMINATION
ts,
M
DE
S
(Follow instructions at end of form in answering all questions)
1. Name of applicant Myn M. HOFFMAN tu 911
IN
1/2
Bureau of Medicine & Surgery,
Address Navy Department,
City Washington, D.C. State
gelatoe
sr Hogg-
M
2. Age
Height
70311
Weight
180
3. General physique
Heavy.
4. Tendency to disease, inherited or otherwise
None.
pa L pa MOLQ
verse
1
s
None.
e
5. Previous history in regard to illness or injury
6. Vision: Right eye; Distant vision
20
Corrected to
By
Left Eye; Distant vision
20
Corrected to
By
NOTE:-Actual vision should be determined on proper letters for 20 foot distance, as, 20-20, 20-30, 20-100, etc.
If glasses are worn state correction.
7. Hearing: Right ear; Watch
-
/40"
Whispered voice
15
/15
-
15
IL vori
Left ear; Watch
/40"
Whispered voice
/15
8. Teeth and gums: (note abnormalities) Normal.
NOTE:-Check chart on other side of blank.
9. Neck: (thyroid glands and other abnormalities) No abnormalities.
10. Spine and extremities: (bones, joints, muscles and feet)
No abnormalities.
TO HW9 ape peeu
gAbjoza
11. Thorax: Respiratory system, bronchi, lungs, pleura, etc.
No abnormalities.
Expiration 36
inches
Inspiration 382
inches
Respiration
18
per minute
12
Arteries: firm but compressable
I
Cardio-vascular system Veine: No
or
No abnormalities.
Heart: (note all signs of cardiac involvement)
JS' vogoweu sug betare
80
114
gug 07, ATSCELE
Pulse
Blood pressure: S
D.
(Over)
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"ocrText": "N I\na\n0\n+\n1.\nff\nm\nI\na\nTHE AMERICAN RED CROSS NURSING SERVICE\nR\nn\nFORM 1193\nREV. 3-3-34\nPHYSICAL EXAMINATION\nts,\nM\nDE\nS\n(Follow instructions at end of form in answering all questions)\n1. Name of applicant Myn M. HOFFMAN tu 911\nIN\n1/2\nBureau of Medicine & Surgery,\nAddress Navy Department,\nCity Washington, D.C. State\ngelatoe\nsr Hogg-\nM\n2. Age\nHeight\n70311\nWeight\n180\n3. General physique\nHeavy.\n4. Tendency to disease, inherited or otherwise\nNone.\npa L pa MOLQ\nverse\n1\ns\nNone.\ne\n5. Previous history in regard to illness or injury\n6. Vision: Right eye; Distant vision\n20\nCorrected to\nBy\nLeft Eye; Distant vision\n20\nCorrected to\nBy\nNOTE:-Actual vision should be determined on proper letters for 20 foot distance, as, 20-20, 20-30, 20-100, etc.\nIf glasses are worn state correction.\n7. Hearing: Right ear; Watch\n-\n/40\"\nWhispered voice\n15\n/15\n-\n15\nIL vori\nLeft ear; Watch\n/40\"\nWhispered voice\n/15\n8. Teeth and gums: (note abnormalities) Normal.\nNOTE:-Check chart on other side of blank.\n9. Neck: (thyroid glands and other abnormalities) No abnormalities.\n10. Spine and extremities: (bones, joints, muscles and feet)\nNo abnormalities.\nTO HW9 ape peeu\ngAbjoza\n11. Thorax: Respiratory system, bronchi, lungs, pleura, etc.\nNo abnormalities.\nExpiration 36\ninches\nInspiration 382\ninches\nRespiration\n18\nper minute\n12\nArteries: firm but compressable\nI\nCardio-vascular system Veine: No\nor\nNo abnormalities.\nHeart: (note all signs of cardiac involvement)\nJS' vogoweu sug betare\n80\n114\ngug 07, ATSCELE\nPulse\nBlood pressure: S\nD.\n(Over)"
}