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D M R 29
.
det
Z
3
THE AMERICAN RED CROSS
DEPARTMENT OF NURSING
NO
THIS
ete.
e.
1
its nefil
e
Physical Examination
1. Name of applicant Bara Hannah Fearn
Address 426 826 R
City new york State
4.4
IS.
T
2. Age
35 yrs
Height 5 ft 60 in Weight 103 th
3. General
physique small in statue hut wall fuilt
Mr.
4. Tendency to disease, inherited or otherwise
none
s.
It,
S
5. to or
Previous history in regard serious illness surgical operation negatine
Fif
6. ho
&
a
Has she had rheumatism ?
a
7. Has she at present or has she ever had hernia
?
no
8. Condition of teeth
good
9. Condition of feet
good
-
10. Abdomen and contained organs
11. Chest and contained organs
hegative
meg.
J.
Girth; expiration
32
linches ; inspiration
36
inches
L
Respiration, rate of
20
Heart, pulse rate
e 76
Right eye (Snellen) 20/15
corrected 20/15 ; lens used +50
to
12. Vision
Left eye (Snellen) 20p 15
corrected to 20/15 ; lens used
+50
13. Hearing: A. D. 15/15 of
A. S.
15/15
14. Urine examination:
Color
stram
Reaction
acid
Specific gravity
1018
Albumen
meg
Casts
none
Leucocytes
fer
Sugar
none
15. Do you recommend applicant for:
we
(a) General hospital service
yea overseas service
(b) no
Tropical service
16. Fill in name and number of base hospital, unit or detachment with which applicant is connected:
Army base hospital
Naval base hospital
Emergency detachment
Navy detachment
Hospital unit
ystems Rochester
M. D.
Date. July 19-1918
Address 845 Lex are buly
All questions MUST be answered; otherwise certificate will not be accepted at head-
quarters.
To be forwarded to Chief Nurse of Unit or to the Local Committee on Red Cross
Nursing Service.
(SEE OTHER SIDE)
Page data
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- Type
- photo
- Media ID
- 4a9b2f1699351f81
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Document data
- ID
- 2661963
- Core
- doc
- Type
- document
DTO data
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"ocrText": "D M R 29\n.\ndet\nZ\n3\nTHE AMERICAN RED CROSS\nDEPARTMENT OF NURSING\nNO\nTHIS\nete.\ne.\n1\nits nefil\ne\nPhysical Examination\n1. Name of applicant Bara Hannah Fearn\nAddress 426 826 R\nCity new york State\n4.4\nIS.\nT\n2. Age\n35 yrs\nHeight 5 ft 60 in Weight 103 th\n3. General\nphysique small in statue hut wall fuilt\nMr.\n4. Tendency to disease, inherited or otherwise\nnone\ns.\nIt,\nS\n5. to or\nPrevious history in regard serious illness surgical operation negatine\nFif\n6. ho\n&\na\nHas she had rheumatism ?\na\n7. Has she at present or has she ever had hernia\n?\nno\n8. Condition of teeth\ngood\n9. Condition of feet\ngood\n-\n10. Abdomen and contained organs\n11. Chest and contained organs\nhegative\nmeg.\nJ.\nGirth; expiration\n32\nlinches ; inspiration\n36\ninches\nL\nRespiration, rate of\n20\nHeart, pulse rate\ne 76\nRight eye (Snellen) 20/15\ncorrected 20/15 ; lens used +50\nto\n12. Vision\nLeft eye (Snellen) 20p 15\ncorrected to 20/15 ; lens used\n+50\n13. Hearing: A. D. 15/15 of\nA. S.\n15/15\n14. Urine examination:\nColor\nstram\nReaction\nacid\nSpecific gravity\n1018\nAlbumen\nmeg\nCasts\nnone\nLeucocytes\nfer\nSugar\nnone\n15. Do you recommend applicant for:\nwe\n(a) General hospital service\nyea overseas service\n(b) no\nTropical service\n16. Fill in name and number of base hospital, unit or detachment with which applicant is connected:\nArmy base hospital\nNaval base hospital\nEmergency detachment\nNavy detachment\nHospital unit\nystems Rochester\nM. D.\nDate. July 19-1918\nAddress 845 Lex are buly\nAll questions MUST be answered; otherwise certificate will not be accepted at head-\nquarters.\nTo be forwarded to Chief Nurse of Unit or to the Local Committee on Red Cross\nNursing Service.\n(SEE OTHER SIDE)"
}