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Miss minuserven
D M R Form No. 29
NURSING SERVICE
E L E (c)
Jacket
PHYSICAL EXAMINATION
work
No
5
I. Name of applicant
Sarah margaret Thomas-
a
Address 315 niagara St
City Eau Claire State Wisconsin.
h.
2. Age 36yrs-
Height 5 ft 10 in. Weight. 170 lbs-
3. General physique
Excellent
4. Tendency to disease, inherited or otherwise
none
5. Previous history in regard to serious illness or surgical operation
None
6. Has she had rheumatism? no
7. Has she at present or has she ever had hernia?
no
8. Condition of teeth
Good
9. Condition of feet
Good.
IO. Abdoment and contained organs normal
II. Chest and contained
organs H eart L Lumys negative
Expiration
57 inches.
Inspiration
41 inches.
I2.
Vision: O. D.20/20 Sph. +.50 40 Hearing: A. D. 2020
O. S. 20/20 L " +12 51 +37"1120
A. S.
NOTE: In case of refractive error state degree of correction by glasses.
13. Urine examination:
Color straw
Reaction
acid
Specific gravity 1015
Albumen
to
Casts
No
Leucocytes a few
Sugar
No
14. Do you recommend applicant for:
(a) General hospital service
applicant is well fitted for head nurse
or any exective work Has done bort Givie statements
(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
CAY
Emergency detachment at
Navy detachment at
Hospital unit at
Surgical section at
S graphine me Allnew M.
D.
Date. Jan 29, 1918
Address 29 8 madison St chicago, 2ll
All questions MUST be answered; otherwise certificate will not be accepted at headquarters.
47
5
To be forwarded to Chief Nurse of Unit or to Committee Organizing Detachment.
5
Req. 17-833-May-2CM
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"ocrText": "Miss minuserven\nD M R Form No. 29\nNURSING SERVICE\nE L E (c)\nJacket\nPHYSICAL EXAMINATION\nwork\nNo\n5\nI. Name of applicant\nSarah margaret Thomas-\na\nAddress 315 niagara St\nCity Eau Claire State Wisconsin.\nh.\n2. Age 36yrs-\nHeight 5 ft 10 in. Weight. 170 lbs-\n3. General physique\nExcellent\n4. Tendency to disease, inherited or otherwise\nnone\n5. Previous history in regard to serious illness or surgical operation\nNone\n6. Has she had rheumatism? no\n7. Has she at present or has she ever had hernia?\nno\n8. Condition of teeth\nGood\n9. Condition of feet\nGood.\nIO. Abdoment and contained organs normal\nII. Chest and contained\norgans H eart L Lumys negative\nExpiration\n57 inches.\nInspiration\n41 inches.\nI2.\nVision: O. D.20/20 Sph. +.50 40 Hearing: A. D. 2020\nO. S. 20/20 L \" +12 51 +37\"1120\nA. S.\nNOTE: In case of refractive error state degree of correction by glasses.\n13. Urine examination:\nColor straw\nReaction\nacid\nSpecific gravity 1015\nAlbumen\nto\nCasts\nNo\nLeucocytes a few\nSugar\nNo\n14. Do you recommend applicant for:\n(a) General hospital service\napplicant is well fitted for head nurse\nor any exective work Has done bort Givie statements\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\nCAY\nEmergency detachment at\nNavy detachment at\nHospital unit at\nSurgical section at\nS graphine me Allnew M.\nD.\nDate. Jan 29, 1918\nAddress 29 8 madison St chicago, 2ll\nAll questions MUST be answered; otherwise certificate will not be accepted at headquarters.\n47\n5\nTo be forwarded to Chief Nurse of Unit or to Committee Organizing Detachment.\n5\nReq. 17-833-May-2CM"
}