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D M R Form No. 29
NURSING SERVICE
TIE 4 Gass is
PHYSICAL EXAMINATION
I. Name of applicant miss Gertrid many Smith
Address. Pelin B. Brighten Hosp City Borlon State moss
2. Age 31
Height 5ft 5/4 in, Weight 137 ll
3. General physique
4. Tendency to disease, inherited or otherwise Parents living and well Bio, 9 Sist,
appear
living will. no known tendency to disease
5. Previous history in regard to serious illness or surgical operation Scalet fever and diphthesia
or no impuris. factory or sprain's turtinals yoo measles A years ago
a child-ms complications, 5 yrs ago; Tendency to "hermon indigation
6.
Has sbe had rheúmatism yes apparently one mild attacle ofac sharm fever
7. Has she at present or has she ever, had hernia? no.
8. Condition of teeth et. Inf. missing 273 it
9. Condition of feet arches fair
general the grinding surfaces
sip missing privole.
IO. Abdomen and contained organs Sear from appear destony-solid", negative
II. Chest and contained organs L imgo sound good; heart neq stire.
Expiration
30%
inches.
Inspiration
32%
inches.
I2. Vision: O. D. 20/20
Hearing: A. D nound
O. S. 20/20
A. S. nonwol
NOTE: In case of refractive error state degree of correction by glasses.
13. Urine examination:
Color Straw
Reaction alkeline
Specific gravity 1020
Albumen not fresent
Casts none
Leucocytes none seen
Sugar not present
14. Do you recommend/applicant for:
(a) General hospital service yes
(b) Tropical service
no
OK
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
etaly
Surgical section at
J.P. Devan
M. D.
Date Dec 26 1917
Address. Peter B Anghay Store
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-May-2CM
/
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"ocrText": "D M R Form No. 29\nNURSING SERVICE\nTIE 4 Gass is\nPHYSICAL EXAMINATION\nI. Name of applicant miss Gertrid many Smith\nAddress. Pelin B. Brighten Hosp City Borlon State moss\n2. Age 31\nHeight 5ft 5/4 in, Weight 137 ll\n3. General physique\n4. Tendency to disease, inherited or otherwise Parents living and well Bio, 9 Sist,\nappear\nliving will. no known tendency to disease\n5. Previous history in regard to serious illness or surgical operation Scalet fever and diphthesia\nor no impuris. factory or sprain's turtinals yoo measles A years ago\na child-ms complications, 5 yrs ago; Tendency to \"hermon indigation\n6.\nHas sbe had rheúmatism yes apparently one mild attacle ofac sharm fever\n7. Has she at present or has she ever, had hernia? no.\n8. Condition of teeth et. Inf. missing 273 it\n9. Condition of feet arches fair\ngeneral the grinding surfaces\nsip missing privole.\nIO. Abdomen and contained organs Sear from appear destony-solid\", negative\nII. Chest and contained organs L imgo sound good; heart neq stire.\nExpiration\n30%\ninches.\nInspiration\n32%\ninches.\nI2. Vision: O. D. 20/20\nHearing: A. D nound\nO. S. 20/20\nA. S. nonwol\nNOTE: In case of refractive error state degree of correction by glasses.\n13. Urine examination:\nColor Straw\nReaction alkeline\nSpecific gravity 1020\nAlbumen not fresent\nCasts none\nLeucocytes none seen\nSugar not present\n14. Do you recommend/applicant for:\n(a) General hospital service yes\n(b) Tropical service\nno\nOK\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\netaly\nSurgical section at\nJ.P. Devan\nM. D.\nDate Dec 26 1917\nAddress. Peter B Anghay Store\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-May-2CM\n/"
}