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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.
Page data
- Page
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- Source index
- 0
- Type
- photo
- Media ID
- d02dba78b6811969
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Document data
- ID
- 2661770
- Core
- doc
- Type
- document
DTO data
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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."
}