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FINAL PHYSICAL EXAMINATION
HARVARD UNIT
FORM 1193
AMERICAN RED CROSS NURSING SERVICE
REV. 10-26-38
S
PHYSICAL EXAMINATION
F
(Follow instructions at end of form in answering all questions)
S
1. Name of applicant
Susan J. Ralph
Address City neu york
State u.y.
2. Age 22
Height 61 wiches
Weight 113 founds
S
3. Family history negative
s
4. Past history: General health, operation, injury, any illnesses scarlet meals
T
mumps, whosping cough, chickenpou in childhood. 7. and a. 1924.
Repart of severed tendon Rt. 4th finger 1939 excellent result.
5. General physique good
6. Eyes: Pupils; Right eye; Distant vision 20/20 Corrected
to
Lens used
-
Left eye; Distant vision 20/20 Corrected to
Lens used
NOTE:-Actual vision should be determined on proper letters for 20 foot distant, as 20-20,20-30,20-100, etc.
If glasses are worn state correction.
7. Ears: normal
8. Teeth and gums: (note abnormalities) in good condition
NOTE:-Check chart on other side of blank.
9. Throat normal
10. Neck: (Thyroid gland and other abnormalities) negative
11. Skeletal: (Bones, joints, muscles and feet) normal
12. Thorax: Expiration
see previous exam inches
see previous exam.
Inspiration
inches
Respiration 18
per minute
Lungs to percussion and auscultation normal
Cardio-vascular system normal
8
Heart: Size normal
N
FEB 4 . 1948
Murmurs none
Pulse 78
Blood pressure: S 116
D 74
U
(Over)
W
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"ocrText": "FINAL PHYSICAL EXAMINATION\nHARVARD UNIT\nFORM 1193\nAMERICAN RED CROSS NURSING SERVICE\nREV. 10-26-38\nS\nPHYSICAL EXAMINATION\nF\n(Follow instructions at end of form in answering all questions)\nS\n1. Name of applicant\nSusan J. Ralph\nAddress City neu york\nState u.y.\n2. Age 22\nHeight 61 wiches\nWeight 113 founds\nS\n3. Family history negative\ns\n4. Past history: General health, operation, injury, any illnesses scarlet meals\nT\nmumps, whosping cough, chickenpou in childhood. 7. and a. 1924.\nRepart of severed tendon Rt. 4th finger 1939 excellent result.\n5. General physique good\n6. Eyes: Pupils; Right eye; Distant vision 20/20 Corrected\nto\nLens used\n-\nLeft eye; Distant vision 20/20 Corrected to\nLens used\nNOTE:-Actual vision should be determined on proper letters for 20 foot distant, as 20-20,20-30,20-100, etc.\nIf glasses are worn state correction.\n7. Ears: normal\n8. Teeth and gums: (note abnormalities) in good condition\nNOTE:-Check chart on other side of blank.\n9. Throat normal\n10. Neck: (Thyroid gland and other abnormalities) negative\n11. Skeletal: (Bones, joints, muscles and feet) normal\n12. Thorax: Expiration\nsee previous exam inches\nsee previous exam.\nInspiration\ninches\nRespiration 18\nper minute\nLungs to percussion and auscultation normal\nCardio-vascular system normal\n8\nHeart: Size normal\nN\nFEB 4 . 1948\nMurmurs none\nPulse 78\nBlood pressure: S 116\nD 74\nU\n(Over)\nW"
}