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FORM 1045
REV. 4-4-38
THE AMERICAN RED CROSS
NATIONAL HEADQUARTERS
WASHINGTON, D. C.
18
QUESTIONNAIRES DESTROVED
+ 3 11
Dear Red Cross Nurse:
The National Committee on Red Cross Nursing Service requires us to submit,
annually, a report of all the Red Cross Nurses enrolled with our Committee. Will you
therefore, please answer the following questions and return this form to me, in the
enclosed envelope, at the earliest possible date? THIS ANNUAL QUESTIONNAIRE IS FILED
WITH YOUR RECORDS AT NATIONAL HEADQUARTERS IN WASHINGTON, D. C. We hope you will rec-
ognize the value of filing this information and will return the questionnaire promptly,
as we are extremely anxious to make a very complete report to National Headquarters.
IMPORTANT:
In order to render prompt service
Yours sincerely,
in time of disaster, enrolled Red Cross
Chairman or
FLORENCE M. JOHNSON
Nurses should report at once to the
Secretary.
Secretary of the Local Committee under
MANHATTAN
Local Committee.
which they are enrolled. Do not forget
the address of the Secretary.
Name in full
Lucy Louisa Joaquim
If married, give husband's name
Permanent address 112 Bella Vista Tuckahoe Westchester
(STREET. ETC.)
(CITY)
(COUNTY)
r.y. ASTATE)
Probable address for the next year same as above
(STREET, ETC.)
Telephone No Tuckahoe 1872
(CITY)
(COUNTY)
(STATE)
Name and address of nearest relative or friend, in United States, through whom you may
be communicated with in an emergency. (State relationship)
Amelia Joaquim (sistes) same address
Underline the type of wórk you are now doing:
Army - Navy - U.S.P.H. Service - Veterans Administration - U.S. Indian Service -
Public Health - Institutional - Private Duty - Industrial - Office Nurse - Registrar.
Are you an instructor of Red Cross classes in Home Hygiene and Care of the Sick? no
Have you ever been? no
Would you like to teach Red Cross classes? ro
Indicate present physical condition good
I
Would you respond to an emergency call in event of epidemic, disaster, war, etc.? yes
5
Badge No. 9592
Current date march 25-1939
I
NOTE. If the nurse does not complete and return this questionnaire, and can not be
N
located within two years, her enrolment will be removed from our active files.
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"ocrText": "FORM 1045\nREV. 4-4-38\nTHE AMERICAN RED CROSS\nNATIONAL HEADQUARTERS\nWASHINGTON, D. C.\n18\nQUESTIONNAIRES DESTROVED\n+ 3 11\nDear Red Cross Nurse:\nThe National Committee on Red Cross Nursing Service requires us to submit,\nannually, a report of all the Red Cross Nurses enrolled with our Committee. Will you\ntherefore, please answer the following questions and return this form to me, in the\nenclosed envelope, at the earliest possible date? THIS ANNUAL QUESTIONNAIRE IS FILED\nWITH YOUR RECORDS AT NATIONAL HEADQUARTERS IN WASHINGTON, D. C. We hope you will rec-\nognize the value of filing this information and will return the questionnaire promptly,\nas we are extremely anxious to make a very complete report to National Headquarters.\nIMPORTANT:\nIn order to render prompt service\nYours sincerely,\nin time of disaster, enrolled Red Cross\nChairman or\nFLORENCE M. JOHNSON\nNurses should report at once to the\nSecretary.\nSecretary of the Local Committee under\nMANHATTAN\nLocal Committee.\nwhich they are enrolled. Do not forget\nthe address of the Secretary.\nName in full\nLucy Louisa Joaquim\nIf married, give husband's name\nPermanent address 112 Bella Vista Tuckahoe Westchester\n(STREET. ETC.)\n(CITY)\n(COUNTY)\nr.y. ASTATE)\nProbable address for the next year same as above\n(STREET, ETC.)\nTelephone No Tuckahoe 1872\n(CITY)\n(COUNTY)\n(STATE)\nName and address of nearest relative or friend, in United States, through whom you may\nbe communicated with in an emergency. (State relationship)\nAmelia Joaquim (sistes) same address\nUnderline the type of wórk you are now doing:\nArmy - Navy - U.S.P.H. Service - Veterans Administration - U.S. Indian Service -\nPublic Health - Institutional - Private Duty - Industrial - Office Nurse - Registrar.\nAre you an instructor of Red Cross classes in Home Hygiene and Care of the Sick? no\nHave you ever been? no\nWould you like to teach Red Cross classes? ro\nIndicate present physical condition good\nI\nWould you respond to an emergency call in event of epidemic, disaster, war, etc.? yes\n5\nBadge No. 9592\nCurrent date march 25-1939\nI\nNOTE. If the nurse does not complete and return this questionnaire, and can not be\nN\nlocated within two years, her enrolment will be removed from our active files."
}