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Form 1460
Rev. April 1942
American Red Cross
Physical Examination Record
Name min magant Someruille
Date of birth
Age 29
Home Address:
City 171 Bevand st;
State Catshil N.Y.
PAST HISTORY
Give history of previous illness and treatments (medical and surgical)
June 1941-
on way to Eyelland, a hip was
tabelined Adrift days.
I
Rached up by British destioner
Epilepsy or convulsive seizures--nervous or mental disease
August 1942 -
ofustam in England:
Thange of 2 centernal
abseever
of left hidney
Is there a history of tuberculosis in the family or among intimate associates? If so, state particulars.
following fircunsultis.
Has juit returned for
Eyplane ni
8 day tuh
with very little sleep.
PHYSICAL EXAMINATION
JAMOTTICA
Ideal
Wt. 118 to
96
Temperature 28
Ht.
Wt. 100%
for Ht.
120
Pulse
General appearance Twid. Physique
pallor
Nutrition
Sl. under unushed Skin and membranes
mucous
? sl. pallu.
/20)
(Rt.
/20)
Vision :
(Rt. eye
With glasses
Without glasses
/20)
(Lt.
/20)
(Lt. eye
Evidence of disease:
Ulive
(Rt.
Hearing :
(Rt. ear
/15)
Evidence of disease
(Lt.
(Whispered voice)
(Lt. ear
/15)
Teeth
Fair
Gums
Artificial dentures
une
Nose and throat
unme
Lymph glands
my
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"ocrText": "Form 1460\nRev. April 1942\nAmerican Red Cross\nPhysical Examination Record\nName min magant Someruille\nDate of birth\nAge 29\nHome Address:\nCity 171 Bevand st;\nState Catshil N.Y.\nPAST HISTORY\nGive history of previous illness and treatments (medical and surgical)\nJune 1941-\non way to Eyelland, a hip was\ntabelined Adrift days.\nI\nRached up by British destioner\nEpilepsy or convulsive seizures--nervous or mental disease\nAugust 1942 -\nofustam in England:\nThange of 2 centernal\nabseever\nof left hidney\nIs there a history of tuberculosis in the family or among intimate associates? If so, state particulars.\nfollowing fircunsultis.\nHas juit returned for\nEyplane ni\n8 day tuh\nwith very little sleep.\nPHYSICAL EXAMINATION\nJAMOTTICA\nIdeal\nWt. 118 to\n96\nTemperature 28\nHt.\nWt. 100%\nfor Ht.\n120\nPulse\nGeneral appearance Twid. Physique\npallor\nNutrition\nSl. under unushed Skin and membranes\nmucous\n? sl. pallu.\n/20)\n(Rt.\n/20)\nVision :\n(Rt. eye\nWith glasses\nWithout glasses\n/20)\n(Lt.\n/20)\n(Lt. eye\nEvidence of disease:\nUlive\n(Rt.\nHearing :\n(Rt. ear\n/15)\nEvidence of disease\n(Lt.\n(Whispered voice)\n(Lt. ear\n/15)\nTeeth\nFair\nGums\nArtificial dentures\nune\nNose and throat\nunme\nLymph glands\nmy"
}