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D M R Form No, 29
m
.
NURSING SERVICE
TIE 4
PHYSICAL EXAMINATION
I. Name of applicant Earily Hanewoud Smich
Address 300 Lorgwood an City Baston
State man
2.
Age 38 years Height 5 ft 2 3/4 / in Weight 125 lko.
3. General physique good
4. Tendency to disease, inherited or otherwise
no
5. Previous history in regard to serious illness or surgical operation no serious illness
no operation
6. Has she had rheumatism?
no
7. Has she at present or has she ever had hiernia? no
8. Condition of teeth
good
9. Condition of feet
good
IO. Abdomen and contained organs
normal
II. Chest and contained organs
normal
Expiration
31
inches.
Inspiration
32"2
inches.
I2. Vision: O. D 20/20
Hearing: A. D normal
O. S. 12/20
A. S. normal
NOTE: In case of refractive error state degree of correction by glasses.
13. Urine examination:
Color
stran
Reaction
aced
Specific gravity
1018
Albumen
0
Casts
O
Leucocytes
0
Sugar
0
14. Do you recommend applicant for:
(a) General hospital service yes
OK
(b) Tropical service
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
Pediatric unit The Chierree Hospital Boston
Navy detachment at
Hospital unit at
Surgical section at.
Date January 9.1918
filler
M. D.
Address 70 $ which Play
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. 17-478-April-3000
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"ocrText": "D M R Form No, 29\nm\n.\nNURSING SERVICE\nTIE 4\nPHYSICAL EXAMINATION\nI. Name of applicant Earily Hanewoud Smich\nAddress 300 Lorgwood an City Baston\nState man\n2.\nAge 38 years Height 5 ft 2 3/4 / in Weight 125 lko.\n3. General physique good\n4. Tendency to disease, inherited or otherwise\nno\n5. Previous history in regard to serious illness or surgical operation no serious illness\nno operation\n6. Has she had rheumatism?\nno\n7. Has she at present or has she ever had hiernia? no\n8. Condition of teeth\ngood\n9. Condition of feet\ngood\nIO. Abdomen and contained organs\nnormal\nII. Chest and contained organs\nnormal\nExpiration\n31\ninches.\nInspiration\n32\"2\ninches.\nI2. Vision: O. D 20/20\nHearing: A. D normal\nO. S. 12/20\nA. S. normal\nNOTE: In case of refractive error state degree of correction by glasses.\n13. Urine examination:\nColor\nstran\nReaction\naced\nSpecific gravity\n1018\nAlbumen\n0\nCasts\nO\nLeucocytes\n0\nSugar\n0\n14. Do you recommend applicant for:\n(a) General hospital service yes\nOK\n(b) Tropical service\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\nPediatric unit The Chierree Hospital Boston\nNavy detachment at\nHospital unit at\nSurgical section at.\nDate January 9.1918\nfiller\nM. D.\nAddress 70 $ which Play\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. 17-478-April-3000"
}