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D M R Form No. 29
THE AMERICAN RED CROSS
CENTRAL DIVISION HEADQUARTERS
180 NORTH WABASH AVENUE
CHICAGO, ILL.
NURSING SERVICE
PHYSICAL EXAMINATION
1.
Name of applicant mabal OkRue
Address 416 W. 1224 City number 11 State my
2. Age
33 you
Height 5' 71" Weight 156 lls. -
3. General physique
good
4. Tendency to disease, inherited or otherwise
none
5. Previous history in regard to serious illness or surgical operation
no operations
new senairy no ill
6. Has she had rheumatism?
7. Has she at present or has she ever had hernia?
no
other
8. Condition of teeth one upper & extracted good
9. Condition of feet good
10. Abdomen and contained organs
Chest and contained organs Heart & hungs veg.
ney
11.
Expiration
34
inches.
Inspiration
36 =
inches.
12. Vision: O. D.
20/20
Hearing: A. D.
ok
O. S.
20/20
A. S.
ok
NOTE: In case of refractive error state degree of correction by glasses.
13. Urine examination:
Color
ablew
acid
Reaction
Specific gravity
1.010
Albumen
7t. trace
Casts
none
Leucocytes
few
Sugar
absent
14. Do you recommend applicant for:
(a) General hospital service.
yes
(b) Tropical service
yes
15. Fill in location of base hospital, unit or detachment with which service is desired:
Army base hospital at
Naval base hospital at
Emergency detachment at
Navy detachment at
Hospital unit at
Surgical section at
H.W. Proun M.
D.
Date quil 6 192)
Address
All questions MUST be answered; otherwise certificate will not be accepted at headquarters.
To be forwarded to Chief Nurse of Unit or to Committee Organizing Detachment.
Req. 17-833-1-3-18-20M
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"ocrText": "D M R Form No. 29\nTHE AMERICAN RED CROSS\nCENTRAL DIVISION HEADQUARTERS\n180 NORTH WABASH AVENUE\nCHICAGO, ILL.\nNURSING SERVICE\nPHYSICAL EXAMINATION\n1.\nName of applicant mabal OkRue\nAddress 416 W. 1224 City number 11 State my\n2. Age\n33 you\nHeight 5' 71\" Weight 156 lls. -\n3. General physique\ngood\n4. Tendency to disease, inherited or otherwise\nnone\n5. Previous history in regard to serious illness or surgical operation\nno operations\nnew senairy no ill\n6. Has she had rheumatism?\n7. Has she at present or has she ever had hernia?\nno\nother\n8. Condition of teeth one upper & extracted good\n9. Condition of feet good\n10. Abdomen and contained organs\nChest and contained organs Heart & hungs veg.\nney\n11.\nExpiration\n34\ninches.\nInspiration\n36 =\ninches.\n12. Vision: O. D.\n20/20\nHearing: A. D.\nok\nO. S.\n20/20\nA. S.\nok\nNOTE: In case of refractive error state degree of correction by glasses.\n13. Urine examination:\nColor\nablew\nacid\nReaction\nSpecific gravity\n1.010\nAlbumen\n7t. trace\nCasts\nnone\nLeucocytes\nfew\nSugar\nabsent\n14. Do you recommend applicant for:\n(a) General hospital service.\nyes\n(b) Tropical service\nyes\n15. Fill in location of base hospital, unit or detachment with which service is desired:\nArmy base hospital at\nNaval base hospital at\nEmergency detachment at\nNavy detachment at\nHospital unit at\nSurgical section at\nH.W. Proun M.\nD.\nDate quil 6 192)\nAddress\nAll questions MUST be answered; otherwise certificate will not be accepted at headquarters.\nTo be forwarded to Chief Nurse of Unit or to Committee Organizing Detachment.\nReq. 17-833-1-3-18-20M"
}