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N D M THE AMERICAN RED CROSS DEPARTMENT OF NURSING 1 + on Physical Examination 1. Name of applicant Transin Wales. Wi Address / 37 East 21 3 City new ynk State helf. 2. Age. 35 Height 5. 9 Weight 154 3. General physique Rabuth a none 4 4. Tendency to disease, inherited or otherwise 5. Previous history in regard to serious illness or surgical operation 19.17 6. Has she had rheumatism ? 7. Has she at present or has she ever had hernia ? no. 4 seto of opposed molars. Good condition D 8. Condition of teeth 5 mobars missing. ii false. - bridge. many fillings 9. Condition of feet Arches good. Halley Valgus (very elight no symptors) 10. Abdomen and contained organs normal. 11. and normal Chest contained organs Girth ; expiration 30% inches inspiration 33% inches Respiration, rate of Heart, pulse rate Right eye (Snellen) 2020 corrected to 12. Vision : ; lens used 7 Left eye (Snellen) 2030 corrected to ; lens used 13. Hearing A. D. 15/15 A. S. 15/15 14. Urine examination : Color Camben clear Reaction acid Specific gravity 1020 Albumen 0 Casts 0 Leucocytes - Sugar D 15. Do you recommend applicant for : (a) General hospital service yes (b) Tropical service year W 16. Fill in name and number of base hospital, unit or detachment with which applicant is connected : Army base hospital Naval base hospital Emergency detachment Navy detachment Hospital unit Rwest M. D. Date Cats Address 41 East 70 new Yor Kity All questions MUST be answered; otherwise certificate will not be accepted at head. quarters. To be forwarded to Chief Nurse of Unit or to the Local Committee on Red Cross Nursing Service. (SEE OTHER SIDE)

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    "ocrText": "N\nD M\nTHE AMERICAN RED CROSS\nDEPARTMENT OF NURSING\n1\n+\non\nPhysical Examination\n1. Name of applicant Transin Wales.\nWi\nAddress\n/\n37 East 21 3\nCity\nnew ynk\nState\nhelf.\n2. Age. 35\nHeight\n5. 9\nWeight\n154\n3. General physique\nRabuth\na\nnone\n4\n4. Tendency to disease, inherited or otherwise\n5. Previous history in regard to serious illness or surgical operation\n19.17\n6. Has she had rheumatism ?\n7. Has she at present or has she ever had hernia\n? no. 4 seto of opposed molars. Good condition\nD\n8.\nCondition of teeth 5 mobars missing. ii false. - bridge. many fillings\n9. Condition of feet Arches good. Halley Valgus (very elight no symptors)\n10. Abdomen and contained organs normal.\n11. and normal\nChest contained organs\nGirth ; expiration\n30%\ninches inspiration\n33%\ninches\nRespiration, rate of\nHeart, pulse rate\nRight eye (Snellen) 2020\ncorrected to\n12. Vision :\n; lens used 7\nLeft eye (Snellen) 2030\ncorrected to\n; lens used\n13. Hearing A. D.\n15/15\nA. S.\n15/15\n14. Urine examination :\nColor\nCamben clear\nReaction\nacid\nSpecific gravity\n1020\nAlbumen\n0\nCasts\n0\nLeucocytes\n-\nSugar\nD\n15. Do you recommend applicant for :\n(a) General hospital service\nyes\n(b) Tropical service\nyear\nW\n16. Fill in name and number of base hospital, unit or detachment with which applicant is connected\n:\nArmy base hospital\nNaval base hospital\nEmergency detachment\nNavy detachment\nHospital unit\nRwest\nM. D.\nDate Cats\nAddress 41 East 70 new Yor Kity\nAll questions MUST be answered; otherwise certificate will not be accepted at head.\nquarters.\nTo be forwarded to Chief Nurse of Unit or to the Local Committee on Red Cross\nNursing Service.\n(SEE OTHER SIDE)"
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