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D M R Form No. 29
THE AMERICAN RED CROSS
CENTRAL DIVISION HEADQUARTERS
180 NORTH WABASH AVENUE
CHICAGO, ILL.
NURSING SERVICE
PHYSICAL EXAMINATION
1.
Name of applicant Tittman, Anna Louise
) 1230 Amsterdam Ave.
CityNew York, , N.Y.
State N.Y.
Temporary Address ) Box 64 Whittier Hall
Permanent
if
% W.A.Tittman -RFD #1. -- Springfield Ills. Illinois.
2. Age 37
Height 59 without Weight 126 Tb ordinary in
shaes
3. General physique
4. Tendency to disease, inherited or otherwise none.
ford
5. Previous history in regard to serious illness or surgical operation Pneumonia at3 years i
light attack Searlet fever as a child.
6. Has she had rheumatism? no
7. Has she at present or has she ever had hernia? no
8. Condition of teeth Incellent
10. Abdomen and contained organs negative
9. Condition of feet frdd
11. contained normal -
Chest and organs
Expiration
22/20
inches.
Inspiration
33
inches.
12.
Vision: O. D. 20/20 for ( t.socyl. Hearing: A.
D.
15/15
O. S. 20/20 sludy 1 to
A. S
15/15
NOTE: In case of refractive error state degree of correction by glasses.
13. Urine examination:
Color Pale amber
Reaction and
Specific gravity 1.020
Albumen absent
Casts
none
Leucocytes normal
Sugar
about
14. Do you recommend applicant for:
(a) General hospital service yrs.
(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
Emergency detachment at
Navy detachment at
Hospital unit at
Surgical section at
M. D.
Date March 13.1922
Address 611 W-110 It.
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--1-3-18-20M
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Document data
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Context sent to Scholar
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"ocrText": "D M R Form No. 29\nTHE AMERICAN RED CROSS\nCENTRAL DIVISION HEADQUARTERS\n180 NORTH WABASH AVENUE\nCHICAGO, ILL.\nNURSING SERVICE\nPHYSICAL EXAMINATION\n1.\nName of applicant Tittman, Anna Louise\n) 1230 Amsterdam Ave.\nCityNew York, , N.Y.\nState N.Y.\nTemporary Address ) Box 64 Whittier Hall\nPermanent\nif\n% W.A.Tittman -RFD #1. -- Springfield Ills. Illinois.\n2. Age 37\nHeight 59 without Weight 126 Tb ordinary in\nshaes\n3. General physique\n4. Tendency to disease, inherited or otherwise none.\nford\n5. Previous history in regard to serious illness or surgical operation Pneumonia at3 years i\nlight attack Searlet fever as a child.\n6. Has she had rheumatism? no\n7. Has she at present or has she ever had hernia? no\n8. Condition of teeth Incellent\n10. Abdomen and contained organs negative\n9. Condition of feet frdd\n11. contained normal -\nChest and organs\nExpiration\n22/20\ninches.\nInspiration\n33\ninches.\n12.\nVision: O. D. 20/20 for ( t.socyl. Hearing: A.\nD.\n15/15\nO. S. 20/20 sludy 1 to\nA. S\n15/15\nNOTE: In case of refractive error state degree of correction by glasses.\n13. Urine examination:\nColor Pale amber\nReaction and\nSpecific gravity 1.020\nAlbumen absent\nCasts\nnone\nLeucocytes normal\nSugar\nabout\n14. Do you recommend applicant for:\n(a) General hospital service yrs.\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\nEmergency detachment at\nNavy detachment at\nHospital unit at\nSurgical section at\nM. D.\nDate March 13.1922\nAddress 611 W-110 It.\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--1-3-18-20M"
}