Questionnaire
This item is a questionnaire filled in by Agnes von Kurowsky.
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OCR Page 1 of 2ATLANTIC DIVISION
QUESTIONNAIRE.
1. Name.
Agnes H. von Kurowsky
2.
Address 426 East 26
- Temporary Permanent ST. newyork n.y-
3. Red Cross Badge Number 17,500
4.
Date of appointment to service
2-8-18
5.
Date of discharge from service
Nov.21-1921 -
6.
Service with Army
MA 6 1922
" Navy
"
"
Red Cross
"
"
United States Public Health Service Sanitary Zone
"
"
Emergency, Influenza Epidemic, Disaster, etc.
7. Condition of health on discharge. Excellent
8.
Condition of health at present time.
"
9.
Approximate date of illness if any and where. -
10. Have you notified the Veterans Bureau or the Red Cross Nursing Service? no. -
11. Are you drawing compensation from the Veterans Bureau?
no
Date tranted.
Number.
Hospitalization if any.
Name and address of doctor by whom examined.
12. Remarks:
the 1922
13. Vocational Training.
no-
Number
Where
What kind.
Length of course.
14. Remarks:
15. Are you drawin- Insurance from the American Red Cross? 40 -
Date granted.
16. Present Occupation. night Supervisor Belleve Hospital
121 are +8,262
new york city
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