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Confidential Report of Medical Examiner

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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 no B. Malaria? B no C. Other fever? C no- D. Any disease or injury not included in pre- D mild attack q Pypliti ceding questions? 2 yrs. ago- 20 recurrence. XII. Has the applicant noticed any recent marked XII. no- gain or loss in flesh? XIII. Would you recommend the applicant to a XIII. reputable Life Insurance Company as a yes prudent risk? XIV. Do you professionally consider the applicant XIV. yes a suitable person, physically, for appoint- ment to overseas work? XV. Would a tropical climate be likely to induce XV. no disease or cause disablement? XVI. Are there any facts known to you, or dis- XVI. none - covered by you, not brought out in the 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 endure the physical and mental strain of overseas work? XVIII. When was the applicant last successfully XVIII. Irequent vaccinated? Hotake" time XIX. Has the applicant had typhoid fever or the anti-typhoid inoculation? XIX homocelation for 4 you 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- typhoid fever, or, in lieu thereof, a certificate by a physician, approved by the Medical Adviser of the Division receiving the application, that such person has recently suffered from the disease for the prevention of which there has been no immunization by vaccination or preventive inoculation. Signature of Medical Examiner Go. at. but M. D. Address No. 1462 R.I.m. washington,2.6

Document source description

This item is a form for Agnes von Kurowsky reporting on her health and physical ability.

Page data

Page
2
Source index
0
Type
photo
Media ID
e23303f1d7afe063
Size
unknown

Document data

ID
6706166
Core
doc
Type
document
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Context sent to Scholar

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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\nno\nB. Malaria?\nB\nno\nC. Other fever?\nC\nno-\nD. Any disease or injury not included in pre-\nD\nmild attack q Pypliti\nceding questions?\n2 yrs. ago- 20 recurrence.\nXII. Has the applicant noticed any recent marked\nXII.\nno-\ngain or loss in flesh?\nXIII. Would you recommend the applicant to a\nXIII.\nreputable Life Insurance Company as a\nyes\nprudent risk?\nXIV. Do you professionally consider the applicant\nXIV. yes\na suitable person, physically, for appoint-\nment to overseas work?\nXV. Would a tropical climate be likely to induce\nXV.\nno\ndisease or cause disablement?\nXVI. Are there any facts known to you, or dis-\nXVI.\nnone -\ncovered by you, not brought out in the\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\nendure the physical and mental strain of\noverseas work?\nXVIII. When was the applicant last successfully\nXVIII. Irequent\nvaccinated?\nHotake\" time\nXIX. Has the applicant had typhoid fever or the\nanti-typhoid inoculation?\nXIX\nhomocelation for\n4 you\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-\ntyphoid fever, or, in lieu thereof, a certificate by a physician, approved by the Medical Adviser of the Division\nreceiving the application, that such person has recently suffered from the disease for the prevention of which there\nhas been no immunization by vaccination or preventive inoculation.\nSignature of Medical Examiner\nGo. at. but\nM. D.\nAddress No. 1462 R.I.m. washington,2.6"
}