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BEORD 03A MADIRAMA
D. Has the applicant ever suffered from any disease
D. no
or functional derangement of the respiratory
system? If yes, state particulars.
lo
E. What is the chest circumferecnce?
E 3 4 "
36"
Upon full inspiration
33"
Upon full expiration?
III. The Circulatory System.
A. What is the temperature of the body (If
III. A
9860
over 99° in the mouth, try another day.)
B. Give the rate and other qualities of the pulse.
B 76.
Record blood-pressure.
adt driw sonstmisupos
C. Does it intermit, or become irregular or un-
C. no
equal?
quini 10 gespaib 10H
D. Does physical examination reveal anything
D now
whatever abnormal in the conditions of the
heart or blood vessels?
10 muibom
E. Has the applicant ever suffered from any dis-
E no.
ease of the circulatory system If yes, de-
scribe.
IV. The Nervous System.
IV.
w.
Has there ever been or is there any disease or
functional derangement of the brain or other
parts of the nervous system If yes, state
particulars. Inquire particularly regarding
headaches, insomnia, nervous exhaustion,
chorea or epilepsy and insanity.
V. The Digestive System.
V.
no.
Has the applicant any disease or functional de-
rangement?
now.
A. Of the stomach ?
A
B. Of the intestines?
B none
none
C. Of the liver ?
C
D. Has there been or is there any tendency to
D
now
chronic constipation?
E
now
E. To diarrhea?
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Document data
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"ocrText": "BEORD 03A MADIRAMA\nD. Has the applicant ever suffered from any disease\nD. no\nor functional derangement of the respiratory\nsystem? If yes, state particulars.\nlo\nE. What is the chest circumferecnce?\nE 3 4 \"\n36\"\nUpon full inspiration\n33\"\nUpon full expiration?\nIII. The Circulatory System.\nA. What is the temperature of the body (If\nIII. A\n9860\nover 99° in the mouth, try another day.)\nB. Give the rate and other qualities of the pulse.\nB 76.\nRecord blood-pressure.\nadt driw sonstmisupos\nC. Does it intermit, or become irregular or un-\nC. no\nequal?\nquini 10 gespaib 10H\nD. Does physical examination reveal anything\nD now\nwhatever abnormal in the conditions of the\nheart or blood vessels?\n10 muibom\nE. Has the applicant ever suffered from any dis-\nE no.\nease of the circulatory system If yes, de-\nscribe.\nIV. The Nervous System.\nIV.\nw.\nHas there ever been or is there any disease or\nfunctional derangement of the brain or other\nparts of the nervous system If yes, state\nparticulars. Inquire particularly regarding\nheadaches, insomnia, nervous exhaustion,\nchorea or epilepsy and insanity.\nV. The Digestive System.\nV.\nno.\nHas the applicant any disease or functional de-\nrangement?\nnow.\nA. Of the stomach ?\nA\nB. Of the intestines?\nB none\nnone\nC. Of the liver ?\nC\nD. Has there been or is there any tendency to\nD\nnow\nchronic constipation?\nE\nnow\nE. To diarrhea?"
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