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FORM 1193
THE AMERICAN RED CROSS NURSING SERVICE
REV. 10-22-36
PHYSICAL EXAMINATION
214
(Follow instructions at end of form in answering all questions)
160
1. Name of applicant Stefanie Schlesinger
sccebreg
46
Address 129 Prospect Place City So Grange State
N.J.
2. Age 42 yrs
Height 5'6"
Weight 214
3.
General physique excellent - though overweight
4. Tendency to disease, inherited or otherwise
migraine headaches
5. Previous history in regard to operation, injury or illness
Tousillectomy 1906
25X180
6. Vision: Right eye; Distant vision 25 Corrected to 20 Lens used myopin Astey
Left eye; Distant vision 30 Corrected to 20- Lens used. Myoperasting
225-504165
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. Hearing: Right ear; Watch normal /40"
Whispered voice normal/15
Left ear; Watch normal/10"
Whispered voice normal /15'
8. Teeth and gums: (note abnormalities) Teeth in repair Grims normal.
NOTE-Check chart on other side of blank.
PJOUK
9. Neck: (Thyroid glands and other abnormalities) normal
10. Spine and extremities; (bones, joints, muscles and feet) normal
11. Thorax: Respiratory system, bronchi, lungs, pleura, etc.
normal
Expiration
46 1/2 inches
Inspiration
43 inches
Respiration
20
per minute
Cardio-vascular system
Heart: (note all signs of cardiac involvement)
normal
Pulse 64 Blood pressure: S 130
D. go
(Over)
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"ocrText": "FORM 1193\nTHE AMERICAN RED CROSS NURSING SERVICE\nREV. 10-22-36\nPHYSICAL EXAMINATION\n214\n(Follow instructions at end of form in answering all questions)\n160\n1. Name of applicant Stefanie Schlesinger\nsccebreg\n46\nAddress 129 Prospect Place City So Grange State\nN.J.\n2. Age 42 yrs\nHeight 5'6\"\nWeight 214\n3.\nGeneral physique excellent - though overweight\n4. Tendency to disease, inherited or otherwise\nmigraine headaches\n5. Previous history in regard to operation, injury or illness\nTousillectomy 1906\n25X180\n6. Vision: Right eye; Distant vision 25 Corrected to 20 Lens used myopin Astey\nLeft eye; Distant vision 30 Corrected to 20- Lens used. Myoperasting\n225-504165\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. Hearing: Right ear; Watch normal /40\"\nWhispered voice normal/15\nLeft ear; Watch normal/10\"\nWhispered voice normal /15'\n8. Teeth and gums: (note abnormalities) Teeth in repair Grims normal.\nNOTE-Check chart on other side of blank.\nPJOUK\n9. Neck: (Thyroid glands and other abnormalities) normal\n10. Spine and extremities; (bones, joints, muscles and feet) normal\n11. Thorax: Respiratory system, bronchi, lungs, pleura, etc.\nnormal\nExpiration\n46 1/2 inches\nInspiration\n43 inches\nRespiration\n20\nper minute\nCardio-vascular system\nHeart: (note all signs of cardiac involvement)\nnormal\nPulse 64 Blood pressure: S 130\nD. go\n(Over)"
}