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San M a 1 F tph 5 unnamed Tran Y B. If a wife, is she now pregnant? B. D XI. Has the applicant ever had- XI. ciis I A. Rheumatism, acute or chronic? A Mo B. Malaria? B. uo co ce C. Other fever? C. no L D. Any disease or injury not included in pre- D no C ceding questions re XII. Has the applicant noticed any recent marked XII. gain or loss in fleshi a XIII. Would you recommend the applicant to a XIII. you reputable Life Insurance Company as a pru- dent risk XIV. Do you professionally consider the applicant a suitable person, physically, for appointment XIV. you to overseas work XV. Would a tropical climate be likely to induce XV. not uncessary disease or cause disablement? TIV XVI. Are there any facts known to you, or dis- XVI. to covered by you, not brought out in the above questions, affecting or likely to affect the health of the applicant? If so, please state them. as XVII. Is there, in general, a soundness of constitu- XVII. yrs tion and a vigor of health which give reason- able probability that the applicant can endure the physical and mental strain of overseas work? XVIII. When was the applicant last successfully XVIII. 1917- vaccinated? XIX. Has the applicant had typhoid fever or the anti-typhoid inoculation ? XIX. fab 1918- NOTE Before final credentials are issued to any person enrolled for foreign service for the American Red Cross, a certificate or certificates must be furnished of vaccination and inoculation against smallpox, typhoid and para- typhoid fever, or in lieu thereof, a certificate by a physician, approved by the Medical Adviser of the Division receiving the application, that such person has recently suffered from the disease for the prevention of which there has been no immunization by vaccination or preventive inoculation. alece L mehaves M. D. 3 Signature of Medical Examiner Address 7 84 Park

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