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S
t
a
c
Eila
K
P
Form 596
AMERICAN RED CROSS
Merins Print his
(City and State in which examined)
DIVISION.
apr 25 1921
Confidential Report of Medical Examiner
miss Ella F.M.Germ
In the case of
Address River Pines Sanatirum
Questions to be Answered by Examining Physician.
Note I. Personnel in the foreign service of the American Red Cross often live and work in such trying climates, amid such
insanitary surroundings, exposed to such malignant diseases, and under such a nervous strain incident to loneliness
and expatriation, that only men and women of sound constitution and vigorous health should be recommended for ap-
pointment. It is therefore expected that the Medical Examiner will make the examination thorough and circumstantial
and that he will feel the responsibility of his office, bearing in mind that upon his statements great reliance will be
placed by the American Red Cross. Every question should be answered, as omissions will necessitate correspondence
as to the reasons.
J.
Note 2.
The
examiner will please ask questions calculated to bring out the various symptoms pointing to the several diseases
under each head, fully state any injurious effects of previous illness or injury and give an opinion as to the probability
of its recurrence in the less favorable conditions under which the applicant is to work.
I. A. What is the applicant's age?
I. A
49 yrs
B. Have you had previous acquaintance with the
applicant? How long?
B about 10 years
C. Have you treated him or her professionally?
C no
For what disease or injury?
sill
D. Does the general appearance indicate vigor-
D Vigarus
ous, medium or delicate health?
E. State weight.
E 176
Height.
medium plant
5 gr an
Figure.
F. Is there any deformity or malformation?
F
none
G. What is the temperament, nervous or other-
G
wise?
II. The Respiratory System.
II. A
A. Is the respiration full, easy and regular
yes
State the number of respirations in a min-
ute.
B. Is there any tendency to cough, expectora-
B no
tion or difficulty in breathing?
C. Does the physical examination reveal any-
C. no
thing whatever abnormal in the condition
of the respiratory organs? If yes, explain
fully and state your opinion as to its sig-
nificance.
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Document data
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"ocrText": "S\nt\na\nc\nEila\nK\nP\nForm 596\nAMERICAN RED CROSS\nMerins Print his\n(City and State in which examined)\nDIVISION.\napr 25 1921\nConfidential Report of Medical Examiner\nmiss Ella F.M.Germ\nIn the case of\nAddress River Pines Sanatirum\nQuestions to be Answered by Examining Physician.\nNote I. Personnel in the foreign service of the American Red Cross often live and work in such trying climates, amid such\ninsanitary surroundings, exposed to such malignant diseases, and under such a nervous strain incident to loneliness\nand expatriation, that only men and women of sound constitution and vigorous health should be recommended for ap-\npointment. It is therefore expected that the Medical Examiner will make the examination thorough and circumstantial\nand that he will feel the responsibility of his office, bearing in mind that upon his statements great reliance will be\nplaced by the American Red Cross. Every question should be answered, as omissions will necessitate correspondence\nas to the reasons.\nJ.\nNote 2.\nThe\nexaminer will please ask questions calculated to bring out the various symptoms pointing to the several diseases\nunder each head, fully state any injurious effects of previous illness or injury and give an opinion as to the probability\nof its recurrence in the less favorable conditions under which the applicant is to work.\nI. A. What is the applicant's age?\nI. A\n49 yrs\nB. Have you had previous acquaintance with the\napplicant? How long?\nB about 10 years\nC. Have you treated him or her professionally?\nC no\nFor what disease or injury?\nsill\nD. Does the general appearance indicate vigor-\nD Vigarus\nous, medium or delicate health?\nE. State weight.\nE 176\nHeight.\nmedium plant\n5 gr an\nFigure.\nF. Is there any deformity or malformation?\nF\nnone\nG. What is the temperament, nervous or other-\nG\nwise?\nII. The Respiratory System.\nII. A\nA. Is the respiration full, easy and regular\nyes\nState the number of respirations in a min-\nute.\nB. Is there any tendency to cough, expectora-\nB no\ntion or difficulty in breathing?\nC. Does the physical examination reveal any-\nC. no\nthing whatever abnormal in the condition\nof the respiratory organs? If yes, explain\nfully and state your opinion as to its sig-\nnificance."
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