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D M R Form No. 29
THE CROSS
NURSING SERVICE
ASHINGTON
HUMANIN
DOCUMENT
PHYSICAL EXAMINATION
I. Name of applicant marguello Jacksbewer
Address Grand
City
State Pa
2. Age 22
Height
5'9"
Weight
130
3. General physique Good
4. Tendency to disease, inherited or otherwise
m
5. Previous history in regard to serious illness or surgical operation
now
(
6. Has she had rheumatism? no
7. Has she at present or has she ever had hernia?
no
8. Condition of teeth
Good
9. Condition of feet
Good
IO. Abdomen and contained organs Good
II. Chest and contained organs Good
Expiration
28
inches.
Inspiration
3 /
inches.
I2. Vision : O. D 20/20. pph-50 aph+15oax.go Hearing: A. D 20/20
O. S. 20 / 20 pph. -
A. S.
20/20
NOTE : In case of refractive error state degree of correction by glasses.
I3. Urine examination:
Color
Straw
Reaction
ac
Specific gravity 1017
Albumen no
Casts
now
Leucocytes
Sugar no
14. Do you recommend applicant for:
(a) General hospital service
you
(b) Tropical service
I5. Fill in location of base hospital, unit or detachment with which service is desired
Army base hospital at Wrightsure N.J. Camp Mix
Naval base hospital at
Emergency detachment at
for
Navy detachment at
Hospital unit at
Surgical section at
M.
D.
Date June 4- 18
Address
11f-w-8 Eii Pa
All questions MUST be answered; otherwise certificate will not be accepted at headquarters.
To be forwarded to Chief Nurse of Unit or to Committee Organizing Detachment.
Req. 17-833-May-2cm
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"ocrText": "D M R Form No. 29\nTHE CROSS\nNURSING SERVICE\nASHINGTON\nHUMANIN\nDOCUMENT\nPHYSICAL EXAMINATION\nI. Name of applicant marguello Jacksbewer\nAddress Grand\nCity\nState Pa\n2. Age 22\nHeight\n5'9\"\nWeight\n130\n3. General physique Good\n4. Tendency to disease, inherited or otherwise\nm\n5. Previous history in regard to serious illness or surgical operation\nnow\n(\n6. Has she had rheumatism? no\n7. Has she at present or has she ever had hernia?\nno\n8. Condition of teeth\nGood\n9. Condition of feet\nGood\nIO. Abdomen and contained organs Good\nII. Chest and contained organs Good\nExpiration\n28\ninches.\nInspiration\n3 /\ninches.\nI2. Vision : O. D 20/20. pph-50 aph+15oax.go Hearing: A. D 20/20\nO. S. 20 / 20 pph. -\nA. S.\n20/20\nNOTE : In case of refractive error state degree of correction by glasses.\nI3. Urine examination:\nColor\nStraw\nReaction\nac\nSpecific gravity 1017\nAlbumen no\nCasts\nnow\nLeucocytes\nSugar no\n14. Do you recommend applicant for:\n(a) General hospital service\nyou\n(b) Tropical service\nI5. Fill in location of base hospital, unit or detachment with which service is desired\nArmy base hospital at Wrightsure N.J. Camp Mix\nNaval base hospital at\nEmergency detachment at\nfor\nNavy detachment at\nHospital unit at\nSurgical section at\nM.\nD.\nDate June 4- 18\nAddress\n11f-w-8 Eii Pa\nAll questions MUST be answered; otherwise certificate will not be accepted at headquarters.\nTo be forwarded to Chief Nurse of Unit or to Committee Organizing Detachment.\nReq. 17-833-May-2cm"
}