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Form 1193
Rev. 6-15-25
THE AMERICAN RED CROSS NURSING SERVICE
PHYSICAL EXAMINATION
(Follow instructions at foot of page in answering all questions)
1. Name of applicant Genericus Leprestre
Badge No.
Address 56 Lucretic Place City Portland State Oregon
2. Age 31
Height 5ft. 2"
Weight 114 shepped
3. General physique good. wing
4. Tendency to disease, inherited or otherwise no
5.
Previous history in regard to serious illness or surgical operation affectectomy 1930-
Jousileetoning 1928.
6. Has she had rheumatism ? no
7. Has she at present or has she ever had hernia ? no
8. Condition of teeth good.
B
9. Condition of Bones and Joints good
Flat Foot no
10. Abdomen and contained organs good
11. Chest and contained organs
Girth Expiration
: good. 29
inches. Inspiration 33.
inches
Respiration, rate of 19
Heart, pulse rate 68
Right eye (Snellen) 20/10
Corrected to 20/10
lens used +0502 +050 475
12. Vision
Left eye (Snellen) 20/10
Corrected to 20/10.
lens used +0500+050475
NOTE. - Actual vision should be stated, determined on proper letters for 20 foot distance, as 20,20, 20-50, 20-100, etc. If glasses
good
are state collection.
13. Hearing: Right worn
Left good
Hearing should record whispered voice at 20 feet, as 20-20, 15-20, 10-20, etc.
14. Urine examination :
Color Slaw
Reaction acid
Specific gravity 1020.
Albumen no
Casts no
Leucocytes now.
Sugar no
15. Do you recommend applicant for active hospital service ? yes
M. D.
Date Mar 9th/932
Address 912 wed Denal Protland aregon
All questions MUST be answered; otherwise certificate will not be accepted at Headquarters.
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.
Page data
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- Source index
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- Type
- photo
- Media ID
- 451ef4f3ece5912b
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Document data
- ID
- 2661821
- Core
- doc
- Type
- document
DTO data
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Context sent to Scholar
Document identity
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Document source extras
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"month": 9,
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Page context
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"ocrText": "Form 1193\nRev. 6-15-25\nTHE AMERICAN RED CROSS NURSING SERVICE\nPHYSICAL EXAMINATION\n(Follow instructions at foot of page in answering all questions)\n1. Name of applicant Genericus Leprestre\nBadge No.\nAddress 56 Lucretic Place City Portland State Oregon\n2. Age 31\nHeight 5ft. 2\"\nWeight 114 shepped\n3. General physique good. wing\n4. Tendency to disease, inherited or otherwise no\n5.\nPrevious history in regard to serious illness or surgical operation affectectomy 1930-\nJousileetoning 1928.\n6. Has she had rheumatism ? no\n7. Has she at present or has she ever had hernia ? no\n8. Condition of teeth good.\nB\n9. Condition of Bones and Joints good\nFlat Foot no\n10. Abdomen and contained organs good\n11. Chest and contained organs\nGirth Expiration\n: good. 29\ninches. Inspiration 33.\ninches\nRespiration, rate of 19\nHeart, pulse rate 68\nRight eye (Snellen) 20/10\nCorrected to 20/10\nlens used +0502 +050 475\n12. Vision\nLeft eye (Snellen) 20/10\nCorrected to 20/10.\nlens used +0500+050475\nNOTE. - Actual vision should be stated, determined on proper letters for 20 foot distance, as 20,20, 20-50, 20-100, etc. If glasses\ngood\nare state collection.\n13. Hearing: Right worn\nLeft good\nHearing should record whispered voice at 20 feet, as 20-20, 15-20, 10-20, etc.\n14. Urine examination :\nColor Slaw\nReaction acid\nSpecific gravity 1020.\nAlbumen no\nCasts no\nLeucocytes now.\nSugar no\n15. Do you recommend applicant for active hospital service ? yes\nM. D.\nDate Mar 9th/932\nAddress 912 wed Denal Protland aregon\nAll questions MUST be answered; otherwise certificate will not be accepted at Headquarters.\nTo be forwarded to the Local Committee on Red Cross Nursing Service.\n1. Be 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."
}