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AMERICAN RED CROSS NURSING SERVICE
Form Rev. 6-25-25 1193 THE (Follow
PHYSICAL EXAMINATION
instructions at foot of page in answering all questions)
1.
Name of applicant Mrs. Helen C. La Malle
Badge No.
Address 317 West 45th Sr. City N.Y.
State N.Y.
2. Age
39
Height 5'-7%4"
Weight 163 1/2 lbs
3. General physique
Excellent
4. Tendency to disease, inherited or otherwise
None
5. Previous history in regard to serious illness or surgical operation
Negative
6. Has she had rheumatism ?
No
7. Has she at present or has she ever had hernia
No
8.
Condition of teeth Excellent
9. Condition of Bones and Joints
Normal
Flat Foot
No B
10. Abdomen and contained organs
Normal
11. Chest and contained organs
Heart & Lungs Normal
Girth Expiration
35
inches. Inspiration
37
inches
Respiration, rate of
18
Heart, pulse rate
72
Right eye (Snellen)
20/20
Corrected to
lens used
12. Vision
Left
eye (Snellen) 20/20
Corrected to
lens used
13. Hearing: Right
15/15
Left
15/15
14. Urine examination :
Color
Amber
Reaction
Ac
Specific gravity
1015
Albumen
0
Casts
0
Leucocytes
0
Sugar
o
15. Do you recommend applicant for active hospital service ?
Unqualifiedly
M.D.
MAY -5 926
Date
Address
32- E. .65th SH.
Metropolitan answered; otherwise certificate will be accepted Ino Headquarters. @
All
questions MUST be not at
To be forwarded to the Local Committee on Red Cross Nursing Service.
1.
Be sure that all items are filled in before forwarding. Make definite statements in all instances.
2. Give age in years, height in inches, weight in pounds, stating amount of clothing entering into weight.
8. State what teeth are missing and existing dentistry, such as crowns, plates, etc. State number of opposed molars.
9. Flat foot-state whether or not any inconvenience exists.
11. Chest measurements should be in total inches.
12. Actual vision should be stated, determined on proper letters for 20 foot distance, as 20-20, 20-50, 20-100, etc. If glasses
are worn state correction. Hearing should record whispered voice at 20 feet, as 20-20, 15-20, 10-20, etc.
Page data
- Page
- 46
- Source index
- 0
- Type
- photo
- Media ID
- 915866544897c414
- Size
- unknown
Document data
- ID
- 2661789
- Core
- doc
- Type
- document
DTO data
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Context sent to Scholar
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"ocrText": "AMERICAN RED CROSS NURSING SERVICE\nForm Rev. 6-25-25 1193 THE (Follow\nPHYSICAL EXAMINATION\ninstructions at foot of page in answering all questions)\n1.\nName of applicant Mrs. Helen C. La Malle\nBadge No.\nAddress 317 West 45th Sr. City N.Y.\nState N.Y.\n2. Age\n39\nHeight 5'-7%4\"\nWeight 163 1/2 lbs\n3. General physique\nExcellent\n4. Tendency to disease, inherited or otherwise\nNone\n5. Previous history in regard to serious illness or surgical operation\nNegative\n6. Has she had rheumatism ?\nNo\n7. Has she at present or has she ever had hernia\nNo\n8.\nCondition of teeth Excellent\n9. Condition of Bones and Joints\nNormal\nFlat Foot\nNo B\n10. Abdomen and contained organs\nNormal\n11. Chest and contained organs\nHeart & Lungs Normal\nGirth Expiration\n35\ninches. Inspiration\n37\ninches\nRespiration, rate of\n18\nHeart, pulse rate\n72\nRight eye (Snellen)\n20/20\nCorrected to\nlens used\n12. Vision\nLeft\neye (Snellen) 20/20\nCorrected to\nlens used\n13. Hearing: Right\n15/15\nLeft\n15/15\n14. Urine examination :\nColor\nAmber\nReaction\nAc\nSpecific gravity\n1015\nAlbumen\n0\nCasts\n0\nLeucocytes\n0\nSugar\no\n15. Do you recommend applicant for active hospital service ?\nUnqualifiedly\nM.D.\nMAY -5 926\nDate\nAddress\n32- E. .65th SH.\nMetropolitan answered; otherwise certificate will be accepted Ino Headquarters. @\nAll\nquestions MUST be not at\nTo be forwarded to the Local Committee on Red Cross Nursing Service.\n1.\nBe sure that all items are filled in before forwarding. Make definite statements in all instances.\n2. Give age in years, height in inches, weight in pounds, stating amount of clothing entering into weight.\n8. State what teeth are missing and existing dentistry, such as crowns, plates, etc. State number of opposed molars.\n9. Flat foot-state whether or not any inconvenience exists.\n11. Chest measurements should be in total inches.\n12. Actual vision should be stated, determined on proper letters for 20 foot distance, as 20-20, 20-50, 20-100, etc. If glasses\nare worn state correction. Hearing should record whispered voice at 20 feet, as 20-20, 15-20, 10-20, etc."
}