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Form 596
AMERICAN RED CROSS
The
Pacific
(City and State in which examined)
DIVISION.
apnie 7 19 19
Confidential Report of Medical Examiner
In the case of
stage G. Brucer
Address
Sauta Rosa Caup
Questions to be Answered by Examining Physician.
Note
1.
Personnel in the foreign service of the American Red Cross often live and work in such trying climates, amid such
insanitary surroundings, exposed to such malignant diseases, and under such a nervous strain incident to loneliness
and expatriation, that only men and women of sound constitution and vigorous health should be recommended for ap-
pointment. It is therefore expected that the Medical Examiner will make the examination thorough and circumstantial
and that he will feel the responsibility of his office, bearing in mind that upon his statements great reliance will
be
placed by the American Red Cross. Every question should be answered as omissions will necessitate correspondence
as to the reasons.
Note 2. The examiner will please ask questions calculated to bring out the various symptoms pointing to the several diseases
under each head, fully state any injurious effects of previous illness or injury and give an opinion as to the probability
of its recurrence in the less favorable conditions under which the applicant is to work.
I. A. What is the applicant's age?
I. A
27
B. Have you had previous acquaintance with the
no
applicant? How long?
B
no
C. Have you treated him or her professionally
C
1
For what disease or injury?
D. Does the general appearance indicate vigor-
D Vignous
ous, medium or delicate health?
E. State weight.
E
140
Height.
692
Figure.
murcular
no
F. Is there any deformity or malformation?
F
rauable
G. What is the temperament, nervous or other-
G
wise?
II. The Respiratory System.
II. A
A. Is the respiration full, easy and regular? State
the number of respirations in a minute.
Mr. 16
B. Is there any tendency to cough, expectoration
B
or difficulty in breathing
no
C. Does the physical examination reveal anything
C
whatever abnormal in the condition of the
no
respiratory organs? If yes, explain fully
and state your opinion as to its significance.
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"ocrText": "Form 596\nAMERICAN RED CROSS\nThe\nPacific\n(City and State in which examined)\nDIVISION.\napnie 7 19 19\nConfidential Report of Medical Examiner\nIn the case of\nstage G. Brucer\nAddress\nSauta Rosa Caup\nQuestions to be Answered by Examining Physician.\nNote\n1.\nPersonnel in the foreign service of the American Red Cross often live and work in such trying climates, amid such\ninsanitary surroundings, exposed to such malignant diseases, and under such a nervous strain incident to loneliness\nand expatriation, that only men and women of sound constitution and vigorous health should be recommended for ap-\npointment. It is therefore expected that the Medical Examiner will make the examination thorough and circumstantial\nand that he will feel the responsibility of his office, bearing in mind that upon his statements great reliance will\nbe\nplaced by the American Red Cross. Every question should be answered as omissions will necessitate correspondence\nas to the reasons.\nNote 2. The examiner will please ask questions calculated to bring out the various symptoms pointing to the several diseases\nunder each head, fully state any injurious effects of previous illness or injury and give an opinion as to the probability\nof its recurrence in the less favorable conditions under which the applicant is to work.\nI. A. What is the applicant's age?\nI. A\n27\nB. Have you had previous acquaintance with the\nno\napplicant? How long?\nB\nno\nC. Have you treated him or her professionally\nC\n1\nFor what disease or injury?\nD. Does the general appearance indicate vigor-\nD Vignous\nous, medium or delicate health?\nE. State weight.\nE\n140\nHeight.\n692\nFigure.\nmurcular\nno\nF. Is there any deformity or malformation?\nF\nrauable\nG. What is the temperament, nervous or other-\nG\nwise?\nII. The Respiratory System.\nII. A\nA. Is the respiration full, easy and regular? State\nthe number of respirations in a minute.\nMr. 16\nB. Is there any tendency to cough, expectoration\nB\nor difficulty in breathing\nno\nC. Does the physical examination reveal anything\nC\nwhatever abnormal in the condition of the\nno\nrespiratory organs? If yes, explain fully\nand state your opinion as to its significance."
}