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REPORT OF PHYSICAL EXAMINATION (See AR 40-100 and 40-105) Instructions - Unless otherwise prescribed. this form will be used for all physical examinations of officers, nurses or warrant officers : applicants for appointment as such in che Regular Army National Guard. or Officers Reserve Corps and enrollment in the Reserve Officers' Training Corps. Use typewriter if practicable. Attach plain additional sheets it required. 1. Fulton Lavenia M. (Last name) (First name) (Middle initial) (Serial number) 2 Civilian applicnt for appointment Age 31 Years of service (Grade) (Organization and arm or service) (Nearest birthday) (Whole number only) 3. Nature of examination 1 Appointment Component of Army 2 Army of U.S. 4. Typhoid vaccination. No. series completed 3 Last series October 19 39 5. Date of last smallpox vaccination 1938 Type of reaction Vaccinia 6. Other vaccination or immunity tests Typhus March 1912 7. Medical history 3 Usual childhood diseases: Influenza 1918 No history of Asthma, Hay-fever or Rheumatic-fever. 8. Eyes Normal Distant vision Right 20/ 20 correctible to 20/ by 4 (Snellen type) left 20/ 20 correctible to 20/ by 4 Near vision : Right J# 1 correctible to J# by 4 1 (Jaeger type) Left J# correctible to J# by 4 Refraction 5 (under cycloplegic) : Right Not done Left Not done Color perception (red and green) 6 Normal 9. Ears Normal Hearing (low conversational voice) : Right 20 /20. Left 20 /20. Audiometer (percent loss): Right- Left 10. Nose and throat Normal Tonsils sl. enlarged N.S. 11. Teeth : 7 Right (Examinee's) Left 7 6 5 4 3 2 1 1 2 3 4 5 6 Indicate Restorable carious teeth by o : nonrestorable carious teeth by /: missing natural teeth by X. 16 15 13 12 11 10 9 9 10 11 12 13 Remarks, including other defects None Classification IV Prosthetic dental appliances None 12. Posture Good Figure Medium Frame Medium (Excellent, good. fair, bad) (Slender, medium, stocky, obese) (Light, medium, heavy) 13. Temperature 96.4 Height 62 inches. Weight 118 pounds. Chest; Rest 33inches; inspiration 34 inches expiration 32 inches. Abdomen 28 inches. 14, Cardiovascular system : Heart Normal Blood pressure : S. 105 D. 65 Pulse : Rate-Sitting 76 Immediately after exercise 92 Two minutes after exercise 64 Character Full and Regular Arteries Normal Varicose veins None 15. Respiratory system Normal 16. X-ray of chest 8 Normal 17. Skin and lymphatics Normal Endocrine system Normal 18. Bones, joints, and muscles ormal Feet Normal 19. Abdominal viscera Normal 20. Hernia None Hemorrhoids None 1 Appointment. promotion. retirement. annual active duty, special. Regular Army National Guard Officer's Reserve Corps: Reserve Officer's Training Corps. 3 If annual physical examination, record only for past year. 4 It annual physical examination. record only distant and near vision, and state whether defect is properly corrected. 5 When indicated. 6 Not required for annual physical examination. If rejected for appointment in Regular Army because of malocclusion send plaster models to the Surgeon General Required for candidates for commission. A.GO FORM REPRODUCED HQ. S.O.S. E.T.O.

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    "ocrText": "REPORT OF PHYSICAL EXAMINATION\n(See AR 40-100 and 40-105)\nInstructions - Unless otherwise prescribed. this form will be used for all physical examinations of officers, nurses or warrant officers : applicants for appointment as such in\nche Regular Army National Guard. or Officers Reserve Corps and enrollment in the Reserve Officers' Training Corps. Use typewriter if practicable. Attach plain additional\nsheets it required.\n1.\nFulton\nLavenia\nM.\n(Last name)\n(First name)\n(Middle initial)\n(Serial number)\n2 Civilian applicnt for appointment\nAge 31\nYears of service\n(Grade)\n(Organization and arm or service)\n(Nearest birthday)\n(Whole number only)\n3. Nature of examination 1\nAppointment\nComponent of Army\n2\nArmy of U.S.\n4. Typhoid vaccination. No. series completed 3\nLast series October\n19\n39\n5. Date of last smallpox vaccination\n1938 Type of reaction\nVaccinia\n6. Other vaccination or immunity tests Typhus March 1912\n7. Medical history 3\nUsual childhood diseases:\nInfluenza 1918\nNo history of Asthma, Hay-fever or Rheumatic-fever.\n8. Eyes\nNormal\nDistant vision Right 20/ 20\ncorrectible to 20/\nby 4\n(Snellen type) left 20/ 20\ncorrectible to 20/\nby 4\nNear vision : Right J#\n1\ncorrectible to J#\nby 4\n1\n(Jaeger type) Left J#\ncorrectible to J#\nby 4\nRefraction 5 (under cycloplegic) : Right\nNot done\nLeft Not done\nColor perception (red and green) 6\nNormal\n9. Ears\nNormal\nHearing (low conversational voice) : Right 20 /20. Left 20 /20. Audiometer (percent loss): Right- Left\n10. Nose and throat\nNormal\nTonsils sl. enlarged N.S.\n11. Teeth : 7\nRight\n(Examinee's)\nLeft\n7\n6\n5\n4\n3\n2\n1\n1\n2\n3\n4\n5\n6\nIndicate Restorable carious teeth by o : nonrestorable carious\nteeth by /: missing natural teeth by X.\n16 15\n13 12 11 10 9\n9 10 11 12 13\nRemarks, including other defects\nNone\nClassification IV\nProsthetic dental appliances\nNone\n12. Posture\nGood\nFigure\nMedium\nFrame Medium\n(Excellent, good. fair, bad)\n(Slender, medium, stocky, obese)\n(Light, medium, heavy)\n13. Temperature 96.4 Height 62 inches. Weight 118 pounds. Chest; Rest 33inches; inspiration 34 inches\nexpiration 32 inches. Abdomen 28 inches.\n14, Cardiovascular system : Heart\nNormal\nBlood pressure : S. 105 D. 65\nPulse : Rate-Sitting\n76\nImmediately after exercise 92\nTwo minutes after exercise 64\nCharacter\nFull and Regular\nArteries\nNormal\nVaricose veins None\n15. Respiratory system Normal\n16. X-ray of chest 8\nNormal\n17. Skin and lymphatics\nNormal\nEndocrine system Normal\n18. Bones, joints, and muscles\normal\nFeet\nNormal\n19. Abdominal viscera\nNormal\n20. Hernia\nNone\nHemorrhoids\nNone\n1\nAppointment. promotion. retirement. annual active duty, special.\nRegular Army National Guard Officer's Reserve Corps: Reserve Officer's Training Corps.\n3\nIf annual physical examination, record only for past year.\n4 It annual physical examination. record only distant and near vision, and state whether defect is properly corrected.\n5\nWhen indicated.\n6\nNot required for annual physical examination.\nIf rejected for appointment in Regular Army because of malocclusion send plaster models to the Surgeon General\nRequired for candidates for commission.\nA.GO FORM\nREPRODUCED\nHQ. S.O.S. E.T.O."
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