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M
I
a
T
,
TO
st
5
Hawaiidant REV. FORM JULY 1193
1
x
1941
AMERICAN RED CROSS
ct
NURSING SERVICE
(Line Te to po
Oct 15th
PHYSICAL EXAMINATION
0
of
(All questions must be answered by definite statements)
(0
1. Name of applicant
Miss Bertha Murphy
+
Address 2101 New Hampshire Ave. City Washington, D. C.
State
45
5'8"
162
2. Age
Height
Weight
(feet and inches)
(pounds)
father d. cerebral accident at advanced age; otherwise healthy
3. Family history
4.
Past history: General health, operation, injury, any illnesses (Indicate dates)
no serious illness Save
streptococcic infection of hands while in training without disability
5. General physique Healthy, tall, large frame, well proportioned
(Rt. eye 20/29
(Rt. 20/
(Rt.
6. Distant Vision: Without glasses
(Lt. eye 20/20
With glasses
Evidence of disease
(Lt. 20/
(Lt.
Note: Actual vision should be determined on proper letters for 20 foot distant, as 20-20,20-30,20-100, etc.
(Rt. ear /20ft.
}
(Rt. none
7. Hearing: (Whispered voice)
Evidence of disease
Lt. ear /20ft.
(Lt home.
good condition; moderate dentistry
8. Teeth and gums: (Note abnormalities)
Directions: Indicate as follows-
Right
$
Applicant's
Left
Missing tooth
U8 7 6 5 4 3 2 1
1 2 3 4 5 6 7 8
Teeth:
Bridgework
LB 7 6 5 4 3 2 1
1 2 3 4 5 6 7 8
Crown
"Plate"-writ out word to indicate plate.
9. Nose and Throat
recent toncillectomy; healthy
10. Neck: (Thyroid gland and other abnormalities) firm thyroid nodule; no evidence of disfunction
11. Skeletal: (Bones, joints, muscles, and feet)
no disabilities; muscular system Well developed
is
12. Thorax: Expiration
36
I
332
inches
Inspiration
inches
16
Respiration
per minute
I
12
normal
Lungs to percussion and auscultation
normal
Cardio-vascular system
Tt'
Heart: Size
normal limits
Murmurs
none
Pulse 84
Blood pressure: Syst
020
Dias.
you
13
(OVER)
170 oppex
Page data
- Page
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- Source index
- 0
- Type
- photo
- Media ID
- 79ca1222c7ce051a
- Size
- unknown
Document data
- ID
- 2662012
- Core
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- Type
- document
DTO data
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Context sent to Scholar
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"ocrText": "M\nI\na\nT\n,\nTO\nst\n5\nHawaiidant REV. FORM JULY 1193\n1\nx\n1941\nAMERICAN RED CROSS\nct\nNURSING SERVICE\n(Line Te to po\nOct 15th\nPHYSICAL EXAMINATION\n0\nof\n(All questions must be answered by definite statements)\n(0\n1. Name of applicant\nMiss Bertha Murphy\n+\nAddress 2101 New Hampshire Ave. City Washington, D. C.\nState\n45\n5'8\"\n162\n2. Age\nHeight\nWeight\n(feet and inches)\n(pounds)\nfather d. cerebral accident at advanced age; otherwise healthy\n3. Family history\n4.\nPast history: General health, operation, injury, any illnesses (Indicate dates)\nno serious illness Save\nstreptococcic infection of hands while in training without disability\n5. General physique Healthy, tall, large frame, well proportioned\n(Rt. eye 20/29\n(Rt. 20/\n(Rt.\n6. Distant Vision: Without glasses\n(Lt. eye 20/20\nWith glasses\nEvidence of disease\n(Lt. 20/\n(Lt.\nNote: Actual vision should be determined on proper letters for 20 foot distant, as 20-20,20-30,20-100, etc.\n(Rt. ear /20ft.\n}\n(Rt. none\n7. Hearing: (Whispered voice)\nEvidence of disease\nLt. ear /20ft.\n(Lt home.\ngood condition; moderate dentistry\n8. Teeth and gums: (Note abnormalities)\nDirections: Indicate as follows-\nRight\n$\nApplicant's\nLeft\nMissing tooth\nU8 7 6 5 4 3 2 1\n1 2 3 4 5 6 7 8\nTeeth:\nBridgework\nLB 7 6 5 4 3 2 1\n1 2 3 4 5 6 7 8\nCrown\n\"Plate\"-writ out word to indicate plate.\n9. Nose and Throat\nrecent toncillectomy; healthy\n10. Neck: (Thyroid gland and other abnormalities) firm thyroid nodule; no evidence of disfunction\n11. Skeletal: (Bones, joints, muscles, and feet)\nno disabilities; muscular system Well developed\nis\n12. Thorax: Expiration\n36\nI\n332\ninches\nInspiration\ninches\n16\nRespiration\nper minute\nI\n12\nnormal\nLungs to percussion and auscultation\nnormal\nCardio-vascular system\nTt'\nHeart: Size\nnormal limits\nMurmurs\nnone\nPulse 84\nBlood pressure: Syst\n020\nDias.\nyou\n13\n(OVER)\n170 oppex"
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