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DMR Form No. 29
MERICAN RED
THE NEUTRALITY GOSS
NURSING SERVICE
ASHINGTON HUMANITY
PHYSICAL EXAMINATION
I.
Address 811 hunclels
Name of applicant. him Helen Kungs bury
City. Houslulu State Hawaii"
2.
Age 40
Height
S: 3 4
Weight 115-
3. General physique
Shony
4. Tendency to disease, inherited or otherwise none
5. Previous history in regard to serious illness or surgical operation
bom
6. Has she had rheumatism?
Eno
no
7. Has she at present or has she ever had hernia?
8. Condition of teeth
Good
9. Condition of feet
no defect
IO. Abdomen and contained organs
normal
II. Chest and contained organs
"
26
Expiration
inches.
31
Inspiration
inches.
/20 20 30
Hearing: A. D.
20
12. Vision O. D.
20
O. S
/20
A. S.
20
NOTE In case of refractive error state degree of correction by glasses.
13. Urine examination:
Color amber
Reaction
acid
Specific gravity
1020
Albumen
home
Casts
no
Leucocytes
home
Sugar
m
B
14. Do you recommend applicant for:
(a) General hospital service
yes
(b) Tropical service
15. Fill in location of base hospital, unit or detachment with which service is desired:
Army base hospital at
Naval base hospital at
Emergency detachment at
Navy detachment at
Hospital unit at
Surgical section at
over Seas -
autum M. D.
Date July 19/18
Address Honolulu Hawain
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--20M
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"ocrText": "DMR Form No. 29\nMERICAN RED\nTHE NEUTRALITY GOSS\nNURSING SERVICE\nASHINGTON HUMANITY\nPHYSICAL EXAMINATION\nI.\nAddress 811 hunclels\nName of applicant. him Helen Kungs bury\nCity. Houslulu State Hawaii\"\n2.\nAge 40\nHeight\nS: 3 4\nWeight 115-\n3. General physique\nShony\n4. Tendency to disease, inherited or otherwise none\n5. Previous history in regard to serious illness or surgical operation\nbom\n6. Has she had rheumatism?\nEno\nno\n7. Has she at present or has she ever had hernia?\n8. Condition of teeth\nGood\n9. Condition of feet\nno defect\nIO. Abdomen and contained organs\nnormal\nII. Chest and contained organs\n\"\n26\nExpiration\ninches.\n31\nInspiration\ninches.\n/20 20 30\nHearing: A. D.\n20\n12. Vision O. D.\n20\nO. S\n/20\nA. S.\n20\nNOTE In case of refractive error state degree of correction by glasses.\n13. Urine examination:\nColor amber\nReaction\nacid\nSpecific gravity\n1020\nAlbumen\nhome\nCasts\nno\nLeucocytes\nhome\nSugar\nm\nB\n14. Do you recommend applicant for:\n(a) General hospital service\nyes\n(b) Tropical service\n15. Fill in location of base hospital, unit or detachment with which service is desired:\nArmy base hospital at\nNaval base hospital at\nEmergency detachment at\nNavy detachment at\nHospital unit at\nSurgical section at\nover Seas -\nautum M. D.\nDate July 19/18\nAddress Honolulu Hawain\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--20M"
}