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D MR Form No. 29
AMERICAN REDUCTION
NURSING SERVICE
TH
GOOSE
4
ASHINGTON
HUMANIX
D
PHYSICAL EXAMINATION
me Calla
34 8 52 - SaRe.
McCulla, Alice R.
I. Name of applicant
Address
728 Kinan Street
City. Honolulu
State
T.H.
40
2. Age
Height 5 ft. 9
Weight
141
Good
Double lobar
3. General physique
pneumonia in 1912
4. Tendency to disease, inherited or otherwise
None
Rec. O.K.
5. Previous history in regard to serious illness or surgical operation No serious illness or surgical
operation
6. Has she had rheumatism?
No
No
7. Has she at present or has she ever had hernia?
8. Condition of teeth
O.K.
9. Condition of feet
O.K.
IO. Abdomen and contained organs
O.K.
II. Chest and contained organs
Expiration 35
inches.
Present weight - same
Most ever weighed 141, May 16 1919
38
Inspiration
inches.
I2. Vision O. D
/20
Hearing: A. D.
Normal
O. S
/20
A. S.
NOTE: In case of refractive error state degree of correction by glasses.
13. Urine examination:
Color
light yellow
Reaction
acid
1015
none
Specific gravity
Albumen
Casts
none
Leucocytes
none
Sugar
none
14. Do you recommend applicant for:
(a) General hospital service
What recommendation? - To be returned
because of homesidiness and
(b) Tropical service
incompatibility.
15. 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
(Signed) S. M. Evserov
M. D.
Sept. 1919
Date
Address
Vladivostok Hospital
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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"ocrText": "D MR Form No. 29\nAMERICAN REDUCTION\nNURSING SERVICE\nTH\nGOOSE\n4\nASHINGTON\nHUMANIX\nD\nPHYSICAL EXAMINATION\nme Calla\n34 8 52 - SaRe.\nMcCulla, Alice R.\nI. Name of applicant\nAddress\n728 Kinan Street\nCity. Honolulu\nState\nT.H.\n40\n2. Age\nHeight 5 ft. 9\nWeight\n141\nGood\nDouble lobar\n3. General physique\npneumonia in 1912\n4. Tendency to disease, inherited or otherwise\nNone\nRec. O.K.\n5. Previous history in regard to serious illness or surgical operation No serious illness or surgical\noperation\n6. Has she had rheumatism?\nNo\nNo\n7. Has she at present or has she ever had hernia?\n8. Condition of teeth\nO.K.\n9. Condition of feet\nO.K.\nIO. Abdomen and contained organs\nO.K.\nII. Chest and contained organs\nExpiration 35\ninches.\nPresent weight - same\nMost ever weighed 141, May 16 1919\n38\nInspiration\ninches.\nI2. Vision O. D\n/20\nHearing: A. D.\nNormal\nO. S\n/20\nA. S.\nNOTE: In case of refractive error state degree of correction by glasses.\n13. Urine examination:\nColor\nlight yellow\nReaction\nacid\n1015\nnone\nSpecific gravity\nAlbumen\nCasts\nnone\nLeucocytes\nnone\nSugar\nnone\n14. Do you recommend applicant for:\n(a) General hospital service\nWhat recommendation? - To be returned\nbecause of homesidiness and\n(b) Tropical service\nincompatibility.\n15. 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\n(Signed) S. M. Evserov\nM. D.\nSept. 1919\nDate\nAddress\nVladivostok Hospital\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"
}