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D
THE AMERICAN RED CROSS
DEPARTMENT OF NURSING
Physical Examination
1. Name of applicant
of
gessen
Marie
Elizabeth
st
Address
37 East
71
new your State new Yark
2. Age
24
Height a 5:6 1/2
Weight 114 if
M
3. General physique
Medium will fuelt well nourished
at
4. None
Tendency to disease, inherited or otherwise
None
5. Previous history in regard to serious illness or surgical operation
E
6. Has she had rheumatism ?
No
-
7. Has she at present or has she ever had hernia?
yo
N
8. Condition of teeth
Normal good / crown - may
a
9. Condition of feet
10. Abdomen and contained organs
Normal
5
11. Chest and contained organs
Normal
Girth 28 1/2
; expiration
inches ; inspiration
30 1/2 inches
Respiration, rate of
16
Heart, pulse rate
66.
Right eye (Snellen) 20/20
corrected to
;
lens used
12. Vision :
Left eye (Snellen) 20/20
corrected to
; lens used
13. Hearing A. D.
15/15
A. S.
10/15
14. Urine examination :
Color
yellow
Reaction
acid
Specific gravity
1019
Albumen
O
Casts
O
Leucocytes
few
Sugar
0
15. Do you recommend applicant for :
(a) General hospital service
yes
H
(b) Tropical service
yes
16.
Fill in name and number of base hospital, unit or detachment with which applicant is connected :
Army base hospital
Naval base hospital
3
Emergency detachment
4
Navy detachment
6
Hospital unit
&
Date 3/19/19
Address Prest: Hool n.y. City.
Lee H Fergion
M. D.
All questions MUST be answered; otherwise certificate will not be accepted at head-
quarters.
To be forwarded to Chief Nurse of Unit or to the Local Committee on Red Cross
Nursing Service.
(SEE OTHER SIDE)
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Document data
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"ocrText": "D\nTHE AMERICAN RED CROSS\nDEPARTMENT OF NURSING\nPhysical Examination\n1. Name of applicant\nof\ngessen\nMarie\nElizabeth\nst\nAddress\n37 East\n71\nnew your State new Yark\n2. Age\n24\nHeight a 5:6 1/2\nWeight 114 if\nM\n3. General physique\nMedium will fuelt well nourished\nat\n4. None\nTendency to disease, inherited or otherwise\nNone\n5. Previous history in regard to serious illness or surgical operation\nE\n6. Has she had rheumatism ?\nNo\n-\n7. Has she at present or has she ever had hernia?\nyo\nN\n8. Condition of teeth\nNormal good / crown - may\na\n9. Condition of feet\n10. Abdomen and contained organs\nNormal\n5\n11. Chest and contained organs\nNormal\nGirth 28 1/2\n; expiration\ninches ; inspiration\n30 1/2 inches\nRespiration, rate of\n16\nHeart, pulse rate\n66.\nRight eye (Snellen) 20/20\ncorrected to\n;\nlens used\n12. Vision :\nLeft eye (Snellen) 20/20\ncorrected to\n; lens used\n13. Hearing A. D.\n15/15\nA. S.\n10/15\n14. Urine examination :\nColor\nyellow\nReaction\nacid\nSpecific gravity\n1019\nAlbumen\nO\nCasts\nO\nLeucocytes\nfew\nSugar\n0\n15. Do you recommend applicant for :\n(a) General hospital service\nyes\nH\n(b) Tropical service\nyes\n16.\nFill in name and number of base hospital, unit or detachment with which applicant is connected :\nArmy base hospital\nNaval base hospital\n3\nEmergency detachment\n4\nNavy detachment\n6\nHospital unit\n&\nDate 3/19/19\nAddress Prest: Hool n.y. City.\nLee H Fergion\nM. D.\nAll questions MUST be answered; otherwise certificate will not be accepted at head-\nquarters.\nTo be forwarded to Chief Nurse of Unit or to the Local Committee on Red Cross\nNursing Service.\n(SEE OTHER SIDE)"
}