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DMR Form No. 29
THE
GROSS
NURSING SERVICE
ED 74
ASHINGTON
HUMANITY
PHYSICAL EXAMINATION
218 S. Caderell are
Special Foreign Infant Service
Welfare Work
I. Name of applicant
Department
Grove. 20
-
Address 1653 Pack M
City Chicago's State elees
2. Age 24
3. General
physique Good
Height 5ft Hin Weight 124
4. Tendency disease,
to inherited or otherwise name
.
5. Previous history in regard to serious illness or surgical operation Appendix
received during acahe assock mav. 3.1917
6. Has she had rheumatism? Eight year ajos slight?
7. Has she at present or has she ever had hernia? none
8. Condition of teeth Good
9.
Condition of feet good
IO. Abdomen and contained organs normal
11. Chest and contained organs normal
Expiration
2 inches.
Inspiration
33/4 inches.
2 gin measurements
12. Vision: O.D.
20/20
Hearing: A. D. normal
O. S. 20, 20
A.S. normal
NOTE : In case of refractive error state degree of correction by glasses.
I3. Urine examination:
Color. Pali straw
Reaction acid
Specific gravity 1020
Albumen negation
Casts Nona
Sugar negative
Leucocytes afew
14. Do you recommend applicant for:
OK
(a) General hospital service.
(b) Tropical service. no.
I5. 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
Date Dex V-1917
M. D.
Address 30 no mich Bod
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-2cm
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Document data
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"ocrText": "DMR Form No. 29\nTHE\nGROSS\nNURSING SERVICE\nED 74\nASHINGTON\nHUMANITY\nPHYSICAL EXAMINATION\n218 S. Caderell are\nSpecial Foreign Infant Service\nWelfare Work\nI. Name of applicant\nDepartment\nGrove. 20\n-\nAddress 1653 Pack M\nCity Chicago's State elees\n2. Age 24\n3. General\nphysique Good\nHeight 5ft Hin Weight 124\n4. Tendency disease,\nto inherited or otherwise name\n.\n5. Previous history in regard to serious illness or surgical operation Appendix\nreceived during acahe assock mav. 3.1917\n6. Has she had rheumatism? Eight year ajos slight?\n7. Has she at present or has she ever had hernia? none\n8. Condition of teeth Good\n9.\nCondition of feet good\nIO. Abdomen and contained organs normal\n11. Chest and contained organs normal\nExpiration\n2 inches.\nInspiration\n33/4 inches.\n2 gin measurements\n12. Vision: O.D.\n20/20\nHearing: A. D. normal\nO. S. 20, 20\nA.S. normal\nNOTE : In case of refractive error state degree of correction by glasses.\nI3. Urine examination:\nColor. Pali straw\nReaction acid\nSpecific gravity 1020\nAlbumen negation\nCasts Nona\nSugar negative\nLeucocytes afew\n14. Do you recommend applicant for:\nOK\n(a) General hospital service.\n(b) Tropical service. no.\nI5. 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\nDate Dex V-1917\nM. D.\nAddress 30 no mich Bod\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-2cm"
}