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D M R 29
5
THE AMERICAN RED CROSS
DEPARTMENT OF NURSING
5
Physical Examination
a
1. Name of applicant agnes mever Shufod
for
0
Address 847 West a. End are City h.ycity State n.4
T
2.
Age 32ys
Height
5 ft I'm
Weight
its
a
-
3. General
physique will developed. well nourished.
I
4. Tendency to disease, inherited or otherwise now
5
5. Previous history in regard to serious illness or surgical operation
none
e
s
6. Has she had rheumatism ? no
7. Has she at present or has she ever had hernia ?
no
M
8. Condition of teeth good
9. Condition of feet good and not flat.
10. Abdomen and contained organs normal
11. Chest and contained organs Heart f lung normal
Girth; expiration
27%2
inches; inspiration
30%
inches
Respiration, rate of
18
Heart, pulse rate
80
Right eye (Snellen) 20/15 ;
; corrected ; ; lens used none
corrected to.
lens used.
12. Vision :
Left eye (Snellen) 20/40
13. Hearing: A. D.
heman
A. S.
namel
2
14. Urine examination:
Color
amber
Reaction
acid
Specific gravity 1024
Albumen
O
Casts
c
Leucocytes
WBCC.
Sugar
0
B
15. Do you recommend applicant for:
(a) General hospital service
yes
(b) Tropical service
-
16.
Fill in name and number of base hospital, unit or detachment with which applicant is connected:
2
Army base hospital
a
Naval base hospital
6
Emergency detachment
6
Navy detachment
Hospital unit
Puebyterian Hospital - h.P.P.
# 650.
Rober L. me Cready
M. D.
Date 8-29-18
Address
157 n84 mil
All questions MUST be answered; otherwise certificate will not be accepted at head-
quarters.
To be forwarded to Chief Nurse of Unit or to the Local Committee on Red Cross
Nursing Service.
(SEE OTHER SIDE)
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- Source index
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- Type
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- Media ID
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Document data
- ID
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- Core
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- Type
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"ocrText": "D M R 29\n5\nTHE AMERICAN RED CROSS\nDEPARTMENT OF NURSING\n5\nPhysical Examination\na\n1. Name of applicant agnes mever Shufod\nfor\n0\nAddress 847 West a. End are City h.ycity State n.4\nT\n2.\nAge 32ys\nHeight\n5 ft I'm\nWeight\nits\na\n-\n3. General\nphysique will developed. well nourished.\nI\n4. Tendency to disease, inherited or otherwise now\n5\n5. Previous history in regard to serious illness or surgical operation\nnone\ne\ns\n6. Has she had rheumatism ? no\n7. Has she at present or has she ever had hernia ?\nno\nM\n8. Condition of teeth good\n9. Condition of feet good and not flat.\n10. Abdomen and contained organs normal\n11. Chest and contained organs Heart f lung normal\nGirth; expiration\n27%2\ninches; inspiration\n30%\ninches\nRespiration, rate of\n18\nHeart, pulse rate\n80\nRight eye (Snellen) 20/15 ;\n; corrected ; ; lens used none\ncorrected to.\nlens used.\n12. Vision :\nLeft eye (Snellen) 20/40\n13. Hearing: A. D.\nheman\nA. S.\nnamel\n2\n14. Urine examination:\nColor\namber\nReaction\nacid\nSpecific gravity 1024\nAlbumen\nO\nCasts\nc\nLeucocytes\nWBCC.\nSugar\n0\nB\n15. Do you recommend applicant for:\n(a) General hospital service\nyes\n(b) Tropical service\n-\n16.\nFill in name and number of base hospital, unit or detachment with which applicant is connected:\n2\nArmy base hospital\na\nNaval base hospital\n6\nEmergency detachment\n6\nNavy detachment\nHospital unit\nPuebyterian Hospital - h.P.P.\n# 650.\nRober L. me Cready\nM. D.\nDate 8-29-18\nAddress\n157 n84 mil\nAll questions MUST be answered; otherwise certificate will not be accepted at head-\nquarters.\nTo be forwarded to Chief Nurse of Unit or to the Local Committee on Red Cross\nNursing Service.\n(SEE OTHER SIDE)"
}