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D, M 2 29 THE AMERICAN RED CROSS DEPARTMENT OF NURSING SOUTHERN DIVISION PHYSICAL EXAMINATION [Be sure that all questions are answered and that statements are definite.] 1. Name of applicant Mrs Ruth Dodd Address State BoardHeatth €ity Columbia State S.C 2. Age (in years) 40 Height (in inches) 66% Weight (in pounds) 122 3. General physique next ron 4. Tendency to disease, inherited or otherwise no 5. Previous history in regard to serious illness or surgical operation appendictory wth E + Influenza, Oct 1919 6. Has she had rheumatism ? no 7. Has she at present or has she ever had hernia? no An I No. molars missing No. incisors missing D lover 8. Condition of teeth Opposed molars Your Plates Full Crowns None 9. Condition of feet - (State whether flat foot exists and whether any inconvenience exists). 10. Abdomen and contained organs was. 11. Chest and contained organs yes (Chest measurements should be in inches). Girth; expiration 3 32 inches; inspiration 35 inches Respiration, rate of 18 Heart, pulse rate 80 Right eye (Snellen) 2020 ; corrected to c ; lens used ( 12. Vision: ? Left eye (Snellen) 20 ; corrected to ( ; lens used \ (Vision should be determined on proper letters for 20 ft. distance as 20 (20, 20/30, etc.) 13. Hearing: A. D. 13715 A. S. 1315 (Hearing should record whispered voice at 15 ft., as 15/15, 10/15, etc.) 14. Urine examination: Color show acil Reaction Specific gravity 1020 Albumen Home Casts none Leucocytes none none Sugar 15. Do you recommend applicant for: (a) General hospital service service Willass work home (b) Tropical service. 3 a 16. Fill in name and number of base hospital, unit or detachment with which applicant is con- nected: 4 Army base hospital 0 Naval base hospital Emergency detachment Navy detachment Hospital unit F m Durham M. D. Date June 251919 Address Columbia SS All questions MUST be answered; otherwise certificate will not be accepted at headquarters. To be forwarded to nearest Local Committee or Division Office.

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0
Type
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Document data

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2661770
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Type
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Page context
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    "ocrText": "D, M 2 29\nTHE AMERICAN RED CROSS\nDEPARTMENT OF NURSING\nSOUTHERN DIVISION\nPHYSICAL EXAMINATION\n[Be sure that all questions are answered and that statements are definite.]\n1.\nName\nof applicant Mrs Ruth Dodd\nAddress State BoardHeatth €ity Columbia State S.C\n2. Age (in years) 40 Height (in inches) 66% Weight (in pounds) 122\n3. General physique next\nron\n4. Tendency to disease, inherited or otherwise no\n5. Previous history in regard to serious illness or surgical operation appendictory\nwth\nE\n+\nInfluenza, Oct 1919\n6. Has she had rheumatism ? no\n7. Has she at present or has she ever had hernia? no\nAn\nI\nNo. molars missing No. incisors missing D\nlover\n8. Condition of teeth\nOpposed molars Your Plates Full Crowns None\n9. Condition of feet -\n(State whether flat foot exists and whether any inconvenience exists).\n10. Abdomen and contained organs was.\n11. Chest and contained organs yes\n(Chest measurements should be in inches).\nGirth; expiration 3 32\ninches; inspiration\n35\ninches\nRespiration, rate of\n18\nHeart, pulse rate\n80\nRight eye (Snellen) 2020 ; corrected\nto\nc\n; lens used\n(\n12. Vision:\n? Left eye (Snellen) 20 ; corrected to\n(\n; lens used\n\\\n(Vision should be determined on proper letters for 20 ft. distance as 20 (20, 20/30, etc.)\n13. Hearing: A. D. 13715\nA. S.\n1315\n(Hearing should record whispered voice at 15 ft., as 15/15, 10/15, etc.)\n14. Urine examination:\nColor show\nacil\nReaction\nSpecific gravity 1020\nAlbumen Home\nCasts\nnone\nLeucocytes none\nnone\nSugar\n15. Do you recommend applicant for:\n(a) General hospital service\nservice\nWillass work home\n(b) Tropical service.\n3\na\n16. Fill in name and number of base hospital, unit or detachment with which applicant is con-\nnected:\n4\nArmy base hospital\n0\nNaval base hospital\nEmergency detachment\nNavy detachment\nHospital unit\nF m Durham M.\nD.\nDate June 251919\nAddress Columbia SS\nAll questions MUST be answered; otherwise certificate will not be accepted at headquarters.\nTo be forwarded to nearest Local Committee or Division Office."
}