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M.G.
6438
AMERICAN RED CROSS NURSING SERVICE
PHYSICAL EXAMINATION
en Boston
-
1. Name of Applicant
Josephan Ample Instill
2. Age
33 yrs.
Height off 6im
Weight
150 the
3. General appearance
good.
4. Are your parents living ?
5.
at what age disease did each die?
6.
Tendency to disease, inherited or otherwise ?
now
7. Previous to or
history in regard serious illness surgical operation affeadatory 6 yrs ago
D
Fixation of nt Kinny fr Floating Kidny. 5 yes ago
8. Have you had rheumatism ?
no
9. Have you at present or have you ever had hernia ?
200
10. Condition of teeth
gards
11. Condition of feet
good
12.
Abdomen and contained organs Scan about 2 inche long on Rt. sides Sean A
st.lumbar region. wish , negatine
13.
Chest and contained organs Heart, negative Lungs - negation
Expiration
33
inches.
Inspiration
34
inches.
14. Vision : O. D.
Hearing : A.D.
O. S.
A.S.
15. Urine Examination :
Color amber
Reaction acid
Specific Gravity 10-20.
Albumen none.
Casts your
Leucocytes Few 2 cattered
Sugar noun.
16. Remarks as to fitness of applicant for :
(a) General hospital
service applient fitted for either
general hospital or
(b) Tropical service
Tropical service
Josh I Modden M. D.
6
Date July 24, 1916.
Address Brooklyn Hospital
4
Resident Physician
3
To be forwarded by thenurse,with duplicate Certificate of Immunity; to Chairman National Committee on
X
Nursing Service, American Red Cross, Washington, D C.
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"ocrText": "M.G.\n6438\nAMERICAN RED CROSS NURSING SERVICE\nPHYSICAL EXAMINATION\nen Boston\n-\n1. Name of Applicant\nJosephan Ample Instill\n2. Age\n33 yrs.\nHeight off 6im\nWeight\n150 the\n3. General appearance\ngood.\n4. Are your parents living ?\n5.\nat what age disease did each die?\n6.\nTendency to disease, inherited or otherwise ?\nnow\n7. Previous to or\nhistory in regard serious illness surgical operation affeadatory 6 yrs ago\nD\nFixation of nt Kinny fr Floating Kidny. 5 yes ago\n8. Have you had rheumatism ?\nno\n9. Have you at present or have you ever had hernia ?\n200\n10. Condition of teeth\ngards\n11. Condition of feet\ngood\n12.\nAbdomen and contained organs Scan about 2 inche long on Rt. sides Sean A\nst.lumbar region. wish , negatine\n13.\nChest and contained organs Heart, negative Lungs - negation\nExpiration\n33\ninches.\nInspiration\n34\ninches.\n14. Vision : O. D.\nHearing : A.D.\nO. S.\nA.S.\n15. Urine Examination :\nColor amber\nReaction acid\nSpecific Gravity 10-20.\nAlbumen none.\nCasts your\nLeucocytes Few 2 cattered\nSugar noun.\n16. Remarks as to fitness of applicant for :\n(a) General hospital\nservice applient fitted for either\ngeneral hospital or\n(b) Tropical service\nTropical service\nJosh I Modden M. D.\n6\nDate July 24, 1916.\nAddress Brooklyn Hospital\n4\nResident Physician\n3\nTo be forwarded by thenurse,with duplicate Certificate of Immunity; to Chairman National Committee on\nX\nNursing Service, American Red Cross, Washington, D C."
}