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D M R Form No. 29
THE AMERICAN RED CROSS
CENTRAL DIVISION HEADQUARTERS
ED 74
180 NORTH WABASH AVENUE
CHICAGO, ILL.
Foreign Service
NURSING SERVICE
PHYSICAL EXAMINATION
1. Name of applicant
Helen B free
Address Oak foresh
City
State
2. Age
41
Height
5-7
Weight
160 1/2
3. General physique
good
4. Tendency to disease, inherited or otherwise
none
5. Previous history in regard to serious illness or surgical operation none
6. Has she had rheumatism?
never
7. Has she at present or has she ever had hernia?
no
[either side
8. Condition of teeth plate for upper in asors A one canine on
9. Condition of feet
perfect
near govacondition
10. Abdomen and contained organs
normal
11. Chest and contained organs normal
Expiration
37
inches.
Inspiration
391/2
inches.
12. Vision: O. D.
1812
/20
Hearing: A. D 20/20
O. S
20 20
A. S. 20/20
NOTE: In case of refractive error state degree of correction by glasses.
13. Urine examination:
Color lamber- clear.
Reaction acid
Specific gravity 1018.
Albumen negative
Casts negative
Leucocytes negative
Sugar negative
14. Do you recommend applicant for:
OK
(a) General hospital service
yes
(b) Tropical service
no
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
Everett Marrie
M. D.
Date Feb 28 1918
Address Date Forest see
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. 17-833-1-3-18-20M
Page data
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Document data
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- Core
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- Type
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DTO data
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Context sent to Scholar
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"ocrText": "D M R Form No. 29\nTHE AMERICAN RED CROSS\nCENTRAL DIVISION HEADQUARTERS\nED 74\n180 NORTH WABASH AVENUE\nCHICAGO, ILL.\nForeign Service\nNURSING SERVICE\nPHYSICAL EXAMINATION\n1. Name of applicant\nHelen B free\nAddress Oak foresh\nCity\nState\n2. Age\n41\nHeight\n5-7\nWeight\n160 1/2\n3. General physique\ngood\n4. Tendency to disease, inherited or otherwise\nnone\n5. Previous history in regard to serious illness or surgical operation none\n6. Has she had rheumatism?\nnever\n7. Has she at present or has she ever had hernia?\nno\n[either side\n8. Condition of teeth plate for upper in asors A one canine on\n9. Condition of feet\nperfect\nnear govacondition\n10. Abdomen and contained organs\nnormal\n11. Chest and contained organs normal\nExpiration\n37\ninches.\nInspiration\n391/2\ninches.\n12. Vision: O. D.\n1812\n/20\nHearing: A. D 20/20\nO. S\n20 20\nA. S. 20/20\nNOTE: In case of refractive error state degree of correction by glasses.\n13. Urine examination:\nColor lamber- clear.\nReaction acid\nSpecific gravity 1018.\nAlbumen negative\nCasts negative\nLeucocytes negative\nSugar negative\n14. Do you recommend applicant for:\nOK\n(a) General hospital service\nyes\n(b) Tropical service\nno\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\nEverett Marrie\nM. D.\nDate Feb 28 1918\nAddress Date Forest see\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. 17-833-1-3-18-20M"
}