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THE AMERICAN RED CROSS NURSING SERVICE
FORM 1193
D
REV. 3-3-34
PHYSICAL EXAMINATION
ed
11'
(Follow instructions at end of form in answering all questions)
a
3° Cibe alle tu
1. Name of applicant Audrey M. Holt
VJ Address 20- - West 36 they City Kansas City State Mo
2. Age
36
Height 6112 5'15" Weight
121
M
3. General physique
Good.
otherwise
pr MOLE
4. Tendency to disease, inherited or
5. Previous history in regard injury
to illness or no serious illness
nor inj ury
6. Vision: Right eye; Distant vision 2%20 Corrected to
By
Left Eye; Distant vision 20/20 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.
B
7. Hearing: Right ear; Watch
25 /40"
Whispered voice
12/15'
IL uori
-
Left ear; Watch 20.44"
Whispered voice
10/151
8. Teeth and gums: (note abnormalities)
Good repair.
NOTE:-Check chart on other side of blank.
9. Neck: (thyroid glands and other abnormalities)
none.
pjeuj
TO'
10. Spine and extremities: (bones, joints, muscles 01, and feet) Norma lo
ID que peeu
11. Thorax: Respiratory system, bronchi, lungs, pleura, etc
Normal.
TO MOLAODE (uoge OL
Expiration 30
inches
Inspiration 34
inches
Respiration
20 per minute
12
Cardio-vascular system
Heart: (note all signs of cardiac involvement) normal
of spgomeu er
Size and position
TS vpgomou sug bojar
ol
Pulse 72 Blood S 118 080
pressure:
(Over)
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"ocrText": "I\n0\n+\nTHE AMERICAN RED CROSS NURSING SERVICE\nFORM 1193\nD\nREV. 3-3-34\nPHYSICAL EXAMINATION\ned\n11'\n(Follow instructions at end of form in answering all questions)\na\n3° Cibe alle tu\n1. Name of applicant Audrey M. Holt\nVJ Address 20- - West 36 they City Kansas City State Mo\n2. Age\n36\nHeight 6112 5'15\" Weight\n121\nM\n3. General physique\nGood.\notherwise\npr MOLE\n4. Tendency to disease, inherited or\n5. Previous history in regard injury\nto illness or no serious illness\nnor inj ury\n6. Vision: Right eye; Distant vision 2%20 Corrected to\nBy\nLeft Eye; Distant vision 20/20 Corrected 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.\nB\n7. Hearing: Right ear; Watch\n25 /40\"\nWhispered voice\n12/15'\nIL uori\n-\nLeft ear; Watch 20.44\"\nWhispered voice\n10/151\n8. Teeth and gums: (note abnormalities)\nGood repair.\nNOTE:-Check chart on other side of blank.\n9. Neck: (thyroid glands and other abnormalities)\nnone.\npjeuj\nTO'\n10. Spine and extremities: (bones, joints, muscles 01, and feet) Norma lo\nID que peeu\n11. Thorax: Respiratory system, bronchi, lungs, pleura, etc\nNormal.\nTO MOLAODE (uoge OL\nExpiration 30\ninches\nInspiration 34\ninches\nRespiration\n20 per minute\n12\nCardio-vascular system\nHeart: (note all signs of cardiac involvement) normal\nof spgomeu er\nSize and position\nTS vpgomou sug bojar\nol\nPulse 72 Blood S 118 080\npressure:\n(Over)"
}