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FORM 1193
AMERICAN RED CROSS NURSING SERVICE
REV. 10-26-38
PHYSICAL EXAMINATION
(Follow instructions at end of form in answering all questions)
1. Name of applicant
Catherine Jamieson Wilson
cl
Address Newcomb Hospital City
Vineland
State N.J.
2. Age
29
Height
5ft 2in
Weight 139
3. Family history Father and mother living and well; 3. brothers and ssisters
all living an well - one brother and sister dead in intanc.
4. Past history: General health, operation, injury, any illnesses Good, appendectomy
1917, tonsill lectomy 1929, No history ofinjury, gen'l childhood diseases
5. General physique
Good
6. Eyes: Pupils; Right eye; Distant vision 20/20 Corrected to
Lens used
Left eye; Distant vision 20/20 Corrected to
Lens used
NOTE:-Actual vision should be determined on proper letters for 20 foot distant, as 20-20, 20-30, 20-100, etc.
If glasses are worn state correction.
7. Ears:
Negative
8. Teeth and gums: (note abnormalities)
Normal
NOTE:-Check chart on other side of blank.
9. Throat
Negative-tomails - absent
10. Neck: (Thyroid gland and other abnormalities)
No thyroid enlargment
or other abnormalities
11. Skeletal: (Bones, joints, muscles and feet)
Negative
12. Thorax: Expiration
1.34
inches
Inspiration 37 inches
Respiration 20 per minute
Lungs to percussion and auscultation negative
Cardio-vascular system
negative
Heart: Size
Normal
Murmurs
None
Pulse
72
Blood pressure: S 105 D
60
(Over)
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"ocrText": "FORM 1193\nAMERICAN RED CROSS NURSING SERVICE\nREV. 10-26-38\nPHYSICAL EXAMINATION\n(Follow instructions at end of form in answering all questions)\n1. Name of applicant\nCatherine Jamieson Wilson\ncl\nAddress Newcomb Hospital City\nVineland\nState N.J.\n2. Age\n29\nHeight\n5ft 2in\nWeight 139\n3. Family history Father and mother living and well; 3. brothers and ssisters\nall living an well - one brother and sister dead in intanc.\n4. Past history: General health, operation, injury, any illnesses Good, appendectomy\n1917, tonsill lectomy 1929, No history ofinjury, gen'l childhood diseases\n5. General physique\nGood\n6. Eyes: Pupils; Right eye; Distant vision 20/20 Corrected to\nLens used\nLeft eye; Distant vision 20/20 Corrected to\nLens used\nNOTE:-Actual vision should be determined on proper letters for 20 foot distant, as 20-20, 20-30, 20-100, etc.\nIf glasses are worn state correction.\n7. Ears:\nNegative\n8. Teeth and gums: (note abnormalities)\nNormal\nNOTE:-Check chart on other side of blank.\n9. Throat\nNegative-tomails - absent\n10. Neck: (Thyroid gland and other abnormalities)\nNo thyroid enlargment\nor other abnormalities\n11. Skeletal: (Bones, joints, muscles and feet)\nNegative\n12. Thorax: Expiration\n1.34\ninches\nInspiration 37 inches\nRespiration 20 per minute\nLungs to percussion and auscultation negative\nCardio-vascular system\nnegative\nHeart: Size\nNormal\nMurmurs\nNone\nPulse\n72\nBlood pressure: S 105 D\n60\n(Over)"
}