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D. M.R. FORM NO. 29
nus
THE COOSE
AMERICAN RED CROSS NURSING SERVICE
HASHINGTON
PHYSICAL EXAMINATION
I. Name of applicant
alya nella Wormwood
Address
141 Faiger weather st. Cambridge
2. Age
Height 5ft /
Weight. 128
3. General appearance. normal
4. Tendency to disease, inherited or otherwise no
5. Previous history in regard to serious illness or surgical operation Scarlet Fever - Dephtheus
Childrens Diseases Pneumonie no operations
6. Have you had rheumatism?
no
7. Have you at present or have you ever had hernia? No
8. Condition of teeth Fairly good
9. Condition of feet Rather low anches but not flat
IO. Abdomen and contained organs normal
II. Chest and contained organs normal
Expiration
31 inches.
Inspiration
33 inches.
12. Vision: O.D. 20
Hearing: A. D. normal
A.S. normal
I3. Urine examination:
Color yellow
Reaction ac
Specific gravity 1022
Albumen 0
Casts 0
Leucocytes good many
Sugar 0
14. Remarks as to fitness of applicant for:
(a) General hospital service. Fit
(b) Tropical service.
Fit
S
Date man 28.1917
OR
M. D.
of
Address. 285
Britin
To be forwarded to the Chairman National Committee on Nursing Service, American Red Cross,
Washington, D. C.
Req. 17-109-Feb.-3000.
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"ocrText": "D. M.R. FORM NO. 29\nnus\nTHE COOSE\nAMERICAN RED CROSS NURSING SERVICE\nHASHINGTON\nPHYSICAL EXAMINATION\nI. Name of applicant\nalya nella Wormwood\nAddress\n141 Faiger weather st. Cambridge\n2. Age\nHeight 5ft /\nWeight. 128\n3. General appearance. normal\n4. Tendency to disease, inherited or otherwise no\n5. Previous history in regard to serious illness or surgical operation Scarlet Fever - Dephtheus\nChildrens Diseases Pneumonie no operations\n6. Have you had rheumatism?\nno\n7. Have you at present or have you ever had hernia? No\n8. Condition of teeth Fairly good\n9. Condition of feet Rather low anches but not flat\nIO. Abdomen and contained organs normal\nII. Chest and contained organs normal\nExpiration\n31 inches.\nInspiration\n33 inches.\n12. Vision: O.D. 20\nHearing: A. D. normal\nA.S. normal\nI3. Urine examination:\nColor yellow\nReaction ac\nSpecific gravity 1022\nAlbumen 0\nCasts 0\nLeucocytes good many\nSugar 0\n14. Remarks as to fitness of applicant for:\n(a) General hospital service. Fit\n(b) Tropical service.\nFit\nS\nDate man 28.1917\nOR\nM. D.\nof\nAddress. 285\nBritin\nTo be forwarded to the Chairman National Committee on Nursing Service, American Red Cross,\nWashington, D. C.\nReq. 17-109-Feb.-3000."
}