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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

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0
Type
photo
Media ID
47535681d0437ce3
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unknown

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2661995
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Document identity
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Document source extras
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    "coverageEndDate": {
        "day": 4,
        "logicalDate": "1941-06-04",
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Page context
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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"
}