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I
0
-
+,
(OAC))
Broog
12. Abdomen and pelvis: (condition of wall, scars, herniae, and abnormality of viscera)
D
Appentectom scar- no ad normality
5
Circumference of abdomen at umbilicus
HOSLE: 25"
13. Urinalysis: QULQTO Sp. Gr 1018 mãopeu Albumin None Sugar None Microscopical None
ber
14. Nervous system: (note organic or functional disorders)
Normal.
M
IT apolex: brents'
15. Has the applicant been recently immunized against, Smallpox yes Typhoid yes
to
16. Remarks on abnormalities not otherwise noted or sufficiently described on this
blank
Very normal
a: Mook: (CPALOTO eug orger
8
Is the applicant fit to perform active duty (Military, Disaster, etc. ?) yes
If not, state type of duty she is physically fitted to perform Any'
Date Jan.23.1995 Il ate mour
Boy E. Owens Examiner M.D.
de
os
so
Colleogeg so
BA
:
2
3
4
6
7
8
9
10
"
12
13
14
IS
se
v
v
v
R
n
IAI
17
18 19 2021222324 252627.282930 31
32
so
01
orpelareo
Indicate missing teeth by "X"; bridge work by C crowns by
plates by word
"plate"
All questions MUST be answered; otherwise certificate will not be accepted at Head-
quarters. To be forwarded to the Local Committee on Red Cross Nursing Service.
or
1. Be sure that all items are filled in before forwarding. Make definite statements in all instances.
2. Give age in years, height in inches, weight in pounds. all
11. Chest measurements should be in total inches.
bHARICVT
THE VWEHICVA HED CHOBa BEBAICE
r
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