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DMR 29
THE AMERICAN RED CROSS
NURSING SERVICE
Physical Examination
I. Name of applicant
Edna I show
Address 97 main At
City Benton Hactor State much
2. Age
30
Height 5ft 4in Weight 145
3. General physique
strong - there built
4.
Tendency to disease, inherited or otherwise none
5. Previous history in regard to serious illness or surgical operation
name
6. Has she had rheumatism?
no
7. Has she at present or has she ever had hernia?
no
8. Condition of teeth
good
Good
9. Condition of feet
IO. Abdomen and contained organs normal
II. Chest and contained organs
normal
Girth; expiration
32
inches; inspiration 35
inches
Respiration, rate of
20
Heart, pulse rate normal 76
20
-
Right eye (Snellen)
; corrected to
; lens used
I2. Vision
{
30
20
Left eye (Snellen)
; corrected to
; lens used -
I3. Hearing: A. D
20
go
A. S
20
20
20
14. Urine examination:
Color straw
Reaction
acid
Specific gravity 1020
Albumen
none
Casts
name
Leucocytes
noni
Sugar
name
I5. Do you recommend applicant for:
OK
(a) General hospital service
yes
(b) Tropical service
no
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
alvan a M. D.
Date march 20 1918
Address Button Harbor mich
All questions MUST be answered; otherwise certificate will not be accepted at head-
quarters.
To be forwarded to Chief Nurse of Unit or to Committee Organizing Detachment.
Req. 17-2125B--20M-Nov.
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"ocrText": "DMR 29\nTHE AMERICAN RED CROSS\nNURSING SERVICE\nPhysical Examination\nI. Name of applicant\nEdna I show\nAddress 97 main At\nCity Benton Hactor State much\n2. Age\n30\nHeight 5ft 4in Weight 145\n3. General physique\nstrong - there built\n4.\nTendency to disease, inherited or otherwise none\n5. Previous history in regard to serious illness or surgical operation\nname\n6. Has she had rheumatism?\nno\n7. Has she at present or has she ever had hernia?\nno\n8. Condition of teeth\ngood\nGood\n9. Condition of feet\nIO. Abdomen and contained organs normal\nII. Chest and contained organs\nnormal\nGirth; expiration\n32\ninches; inspiration 35\ninches\nRespiration, rate of\n20\nHeart, pulse rate normal 76\n20\n-\nRight eye (Snellen)\n; corrected to\n; lens used\nI2. Vision\n{\n30\n20\nLeft eye (Snellen)\n; corrected to\n; lens used -\nI3. Hearing: A. D\n20\ngo\nA. S\n20\n20\n20\n14. Urine examination:\nColor straw\nReaction\nacid\nSpecific gravity 1020\nAlbumen\nnone\nCasts\nname\nLeucocytes\nnoni\nSugar\nname\nI5. Do you recommend applicant for:\nOK\n(a) General hospital service\nyes\n(b) Tropical service\nno\n16. Fill in name and number of base hospital, unit or detachment with which applicant is connected:\nArmy base hospital\nNaval base hospital\nEmergency detachment\nNavy detachment\nHospital unit\nalvan a M. D.\nDate march 20 1918\nAddress Button Harbor mich\nAll questions MUST be answered; otherwise certificate will not be accepted at head-\nquarters.\nTo be forwarded to Chief Nurse of Unit or to Committee Organizing Detachment.\nReq. 17-2125B--20M-Nov."
}