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B. If a wife, is she now pregnant? B. XI. Has the applicant ever had- XI. A. Rheumatism, acute or chronic? A to B. Malaria? B A C ti Sanint C. Other fever? D and & closure neuroy cl D. Any disease or injury not included in pre- ceding questions? XII. Has the applicant noticed any recent marked XII. A vd a gain or loss in flesh ? XIII. Would you recommend the applicant to a reputable Life Insurance Company as a XIII. After prudent risk? XIV. Do you professionally consider the applicant a suitable person, physically, for appoint- XIV. yes ment to overseas work? ti to XV. Would a tropical climate be likely to induce XV. disease or cause disablement? IIIV XVI. Are there any facts known to you, or dis- XVI. to covered by you, not brought out in the vd sd Bluoda sudi above questions, affecting or likely to af- fect the health of the applicant? If so, please state them. XVII. Is there, in general, a soundness of constitu- XVII. yes tion and a vigor of health which give rea- sonable probability that the applicant can X. endure the physical and mental strain of :10 pila 10 etotale 10 overseas work? XVIII. When was the applicant last successfully XVIII. 1914 vaccinated? XIX. Has the applicant had typhoid fever or the anti-typhoid inoculation ? XIX. As NOTE. Before final credentials are issued to any person enrolled for foreign service for the American Red Cross, a certificate or certificates must be furnished of vaccination and inoculation against smallpox, typhoid and para- receiving the application, that such person has recently suffered from the disease for the prevention of which there typhoid fever, or, in lieu thereof, a certificate by a physician, approved by the Medical Adviser of the Division has been no immunization by vaccination or preventive inoculation. Surrence A PUMEHUY Jennery audt M. D. Signature of Medical Examiner. DR. L. A. 2073 E. 9TH ST Address CLEVELAND, OHIO

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    "ocrText": "B. If a wife, is she now pregnant?\nB.\nXI. Has the applicant ever had-\nXI.\nA. Rheumatism, acute or chronic?\nA to\nB. Malaria?\nB A\nC ti\nSanint\nC. Other fever?\nD and & closure neuroy\ncl\nD. Any disease or injury not included in pre-\nceding questions?\nXII. Has the applicant noticed any recent marked\nXII. A\nvd\na\ngain or loss in flesh ?\nXIII. Would you recommend the applicant to a\nreputable Life Insurance Company as a\nXIII. After\nprudent risk?\nXIV. Do you professionally consider the applicant\na suitable person, physically, for appoint-\nXIV. yes\nment to overseas work?\nti\nto\nXV. Would a tropical climate be likely to induce\nXV.\ndisease or cause disablement?\nIIIV\nXVI. Are there any facts known to you, or dis-\nXVI. to\ncovered by you, not brought out in the\nvd sd Bluoda sudi\nabove questions, affecting or likely to af-\nfect the health of the applicant? If so,\nplease state them.\nXVII. Is there, in general, a soundness of constitu-\nXVII. yes\ntion and a vigor of health which give rea-\nsonable probability that the applicant can\nX.\nendure the physical and mental strain of\n:10 pila 10 etotale 10\noverseas work?\nXVIII. When was the applicant last successfully\nXVIII. 1914\nvaccinated?\nXIX. Has the applicant had typhoid fever or the\nanti-typhoid inoculation ?\nXIX.\nAs\nNOTE.\nBefore final credentials are issued to any person enrolled for foreign service for the American Red Cross, a\ncertificate or certificates must be furnished of vaccination and inoculation against smallpox, typhoid and para-\nreceiving the application, that such person has recently suffered from the disease for the prevention of which there\ntyphoid fever, or, in lieu thereof, a certificate by a physician, approved by the Medical Adviser of the Division\nhas been no immunization by vaccination or preventive inoculation.\nSurrence A PUMEHUY Jennery audt\nM. D.\nSignature of Medical Examiner.\nDR. L. A.\n2073 E. 9TH ST\nAddress\nCLEVELAND, OHIO"
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