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Hemrrhoids - loone
DMIBRUM 22080 038 MADIRIMA
Menstrual period - v-days 9280
13. Abdomen: (condition of wall, scars herniae, and abnormality of vicera) bo caes
wall poerd les hereiar
S
Circumference of abdomen at umbilicus
24"
14. Nervous system: (note organic or functional disorders)
legative
S
few agreement
15. Urinalysis: Sp. Gr. 1.012
Albumin
0
o
Sugar
Microscopical eparts
Hemoglobin (Sahli method)
11.7 gm 81%
S
16. Date of immunization against, Smallpox 12.31.40
Typhoid 6-15-40
5
17. Remarks on abnormalities not otherwise noted or sufficiently described on this blank:
T
lione
anso
3
Is the applicant fit to perform active duty (Military, Disaster, etc.?) yes
If not, state type of duty she is physically fitted to perform
Date 1-2-V1
Frederick IS Heart MD.
Examiner
7
&
9
10
"
12
13
se
17
18 19 20 21 22 23 24 25 26 27 28 30
31
32
Indicate missing teeth by "X", bridge work by
crown by
plates by word
"plate",
TOQ
moltatiqueR
All questions MUST be answered; otherwise certificate will not be accepted at Head-
quarters. To be forwarded to the Local Committee on Red Cross Nursing Service.
1.
Be sure that all items are filled in before forwarding. Make definite statements in all instances.
2. Give age in years, height in inches, weight in pounds.
8
12. Chest measurements should be in total inches.
N
U
W
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"ocrText": "Hemrrhoids - loone\nDMIBRUM 22080 038 MADIRIMA\nMenstrual period - v-days 9280\n13. Abdomen: (condition of wall, scars herniae, and abnormality of vicera) bo caes\nwall poerd les hereiar\nS\nCircumference of abdomen at umbilicus\n24\"\n14. Nervous system: (note organic or functional disorders)\nlegative\nS\nfew agreement\n15. Urinalysis: Sp. Gr. 1.012\nAlbumin\n0\no\nSugar\nMicroscopical eparts\nHemoglobin (Sahli method)\n11.7 gm 81%\nS\n16. Date of immunization against, Smallpox 12.31.40\nTyphoid 6-15-40\n5\n17. Remarks on abnormalities not otherwise noted or sufficiently described on this blank:\nT\nlione\nanso\n3\nIs the applicant fit to perform active duty (Military, Disaster, etc.?) yes\nIf not, state type of duty she is physically fitted to perform\nDate 1-2-V1\nFrederick IS Heart MD.\nExaminer\n7\n&\n9\n10\n\"\n12\n13\nse\n17\n18 19 20 21 22 23 24 25 26 27 28 30\n31\n32\nIndicate missing teeth by \"X\", bridge work by\ncrown by\nplates by word\n\"plate\",\nTOQ\nmoltatiqueR\nAll questions MUST be answered; otherwise certificate will not be accepted at Head-\nquarters. To be forwarded to the Local Committee on Red Cross Nursing Service.\n1.\nBe sure that all items are filled in before forwarding. Make definite statements in all instances.\n2. Give age in years, height in inches, weight in pounds.\n8\n12. Chest measurements should be in total inches.\nN\nU\nW"
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