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D M R Form No. 29
E
Joh
NURSING SERVICE
-
THI
n
KILLUMANIA
PHYSICAL EXAMINATION
ASHINGTON
s
(Altandar)
on
I. Name of applicant Lena mary Aleander
Address. 913 quen st.
City augusta
State Georgia
2. Age. 28
Height 5ft 3inches Weight 102
Mrs
S.
3. General physique Dender
4. Tendency to disease, inherited or otherwise
no tundency of inhintonce to desire
5. Previous history in regard to serious illness or surgical operation
2 year ago.
a
6. Has she had rheumatism? no
7. Has she at present or has she ever had hernia? no
8. Condition of teeth good
9. Condition of feet good
e
1
IO. Abdomen and contained organs normal
II. Chest and contained organs normal
Expiration 29
inches.
Inspiration 32
inches.
I2. Vision: O. D. 20/20.... -
Hearing: A. D. 20,ft.
O. S. 20/20- -
A. S. 20+1+
NOTE: In case of refractive error state degree of correction by glasses. mars +3703
13. Urine examination:
Color show
Reaction acid
Specific gravity 1020
Albumen no
Casts.
no
Leucocytes no
Sugar
no
14. Do you recommend applicant for:
(a) General hospital service. yes
OK
CHC
(b) Tropical service
yes
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
atlanta Ja .
Surgical section at
AWilliam than
M. D.
Date
Address. angula Ga
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-May--20M
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"ocrText": "D M R Form No. 29\nE\nJoh\nNURSING SERVICE\n-\nTHI\nn\nKILLUMANIA\nPHYSICAL EXAMINATION\nASHINGTON\ns\n(Altandar)\non\nI. Name of applicant Lena mary Aleander\nAddress. 913 quen st.\nCity augusta\nState Georgia\n2. Age. 28\nHeight 5ft 3inches Weight 102\nMrs\nS.\n3. General physique Dender\n4. Tendency to disease, inherited or otherwise\nno tundency of inhintonce to desire\n5. Previous history in regard to serious illness or surgical operation\n2 year ago.\na\n6. Has she had rheumatism? no\n7. Has she at present or has she ever had hernia? no\n8. Condition of teeth good\n9. Condition of feet good\ne\n1\nIO. Abdomen and contained organs normal\nII. Chest and contained organs normal\nExpiration 29\ninches.\nInspiration 32\ninches.\nI2. Vision: O. D. 20/20.... -\nHearing: A. D. 20,ft.\nO. S. 20/20- -\nA. S. 20+1+\nNOTE: In case of refractive error state degree of correction by glasses. mars +3703\n13. Urine examination:\nColor show\nReaction acid\nSpecific gravity 1020\nAlbumen no\nCasts.\nno\nLeucocytes no\nSugar\nno\n14. Do you recommend applicant for:\n(a) General hospital service. yes\nOK\nCHC\n(b) Tropical service\nyes\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\natlanta Ja .\nSurgical section at\nAWilliam than\nM. D.\nDate\nAddress. angula Ga\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-May--20M"
}