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A.R
FORM 1193
3
HAWAII UNIT
REV. JULY 1941
.
AMERICAN RED CROSS
JUN 6 - 1942 -
S
with
NURSING SERVICE
Beferrou
+
PHYSICAL EXAMINATION
(All questions must be answered by definite statements)
Brusing
ep
5
1.
Name of applicant Stephanie Famice Foto
Address 2712 Clairmout ber City Byham
State
Clu
2. Age
35
Height
61
Weight
113
(feet and inches)
(pounds)
3. Family history
Req for Cancer - T.B. or Kedney hireble
4. Past history: health, operation, injury, any (Indicate dates)
General illnesses Greend health
good. Operation for Bunion 3/7/42 Crimp lete Recovery
5. General Food.
physique
(Rt. eye 20/20
6. Distant Vision: Without glasses
(Lt. eye 20/3a)
With glasses (Rt. Lt. 20/20/ 20/10/ Evidence of disease (Lt. (Rt no no
Note: Actual vision should be determined on proper letters for 20 foot distant, as 20-20, 20-30, 20-100, etc.
Rt.
ear 2920 ft.
(Rt.
no
7. Hearing: (Whispered voice)
Evidence of disease
Lt. ear 2921 ft.
(Lt
no
hormal -
8. Teeth and gums: (Note abnormalities)
Directions: Indicate as follows-
Right
Applicant's
Left
X
Missing tooth
URC 7 6 5 4 3 2 1
1 2 3 4 5 6 7 8
Teeth:
Bridgework
18 7 6 & 4 3 2 1 1 2 3 4 5 6 7 of
Crown
"Plate"-write out word to indicate plate.
9. Nose and Throat
11 normal
10. Neck: (Thyroid gland and other abnormalities) normal
11. Skeletal: (Bones, joints, muscles, and feet)
horemal.
12. Thorax: Expiration
30 1/2 inches
Inspiration
3 3 inches
Respiration
18 minute
per
Lungs to percussion and auscultation Then al
Cardio-vascular system
normal
Heart: Size
horn al 52-mood
Murmurs
none
90,
Pulse
Blood pressure: Syst. 110 Dias. 74
13
(OVER)
8
N
Page data
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- Type
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- Core
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- Type
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DTO data
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Context sent to Scholar
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Document source extras
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"ocrText": "Fl\n0\n+\nA.R\nFORM 1193\n3\nHAWAII UNIT\nREV. JULY 1941\n.\nAMERICAN RED CROSS\nJUN 6 - 1942 -\nS\nwith\nNURSING SERVICE\nBeferrou\n+\nPHYSICAL EXAMINATION\n(All questions must be answered by definite statements)\nBrusing\nep\n5\n1.\nName of applicant Stephanie Famice Foto\nAddress 2712 Clairmout ber City Byham\nState\nClu\n2. Age\n35\nHeight\n61\nWeight\n113\n(feet and inches)\n(pounds)\n3. Family history\nReq for Cancer - T.B. or Kedney hireble\n4. Past history: health, operation, injury, any (Indicate dates)\nGeneral illnesses Greend health\ngood. Operation for Bunion 3/7/42 Crimp lete Recovery\n5. General Food.\nphysique\n(Rt. eye 20/20\n6. Distant Vision: Without glasses\n(Lt. eye 20/3a)\nWith glasses (Rt. Lt. 20/20/ 20/10/ Evidence of disease (Lt. (Rt no no\nNote: Actual vision should be determined on proper letters for 20 foot distant, as 20-20, 20-30, 20-100, etc.\nRt.\near 2920 ft.\n(Rt.\nno\n7. Hearing: (Whispered voice)\nEvidence of disease\nLt. ear 2921 ft.\n(Lt\nno\nhormal -\n8. Teeth and gums: (Note abnormalities)\nDirections: Indicate as follows-\nRight\nApplicant's\nLeft\nX\nMissing tooth\nURC 7 6 5 4 3 2 1\n1 2 3 4 5 6 7 8\nTeeth:\nBridgework\n18 7 6 & 4 3 2 1 1 2 3 4 5 6 7 of\nCrown\n\"Plate\"-write out word to indicate plate.\n9. Nose and Throat\n11 normal\n10. Neck: (Thyroid gland and other abnormalities) normal\n11. Skeletal: (Bones, joints, muscles, and feet)\nhoremal.\n12. Thorax: Expiration\n30 1/2 inches\nInspiration\n3 3 inches\nRespiration\n18 minute\nper\nLungs to percussion and auscultation Then al\nCardio-vascular system\nnormal\nHeart: Size\nhorn al 52-mood\nMurmurs\nnone\n90,\nPulse\nBlood pressure: Syst. 110 Dias. 74\n13\n(OVER)\n8\nN"
}