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DMR29-N.E.D.
THE AMERICAN RED CROSS
DEPARTMENT OF NURSING
Physical Examination
1. Name of applicant
Address 238 Webster Street City East Boston State mease
Stella Goostray
2. Age 33
Height Weight 122 (indoor clothes
3. General physique ford.
4. Tendency to disease, inherited or otherwise none.
5. Previous history in regard to serious illness or surgical operation Typloid Fever 1916.
Complicated with persumonia.
6. Has she had rheumatism ? Following typleod no offand on for 6mos. 1916
7. Has she at present or has she ever had hernia?
8. Condition of teeth good Crounds - ( (nular - I licenseal
9.
Condition of feet Rt. foot arch flattered no meonvenence
10. Abdomen and contained organs negative
11. Chest and contained organs negative
Girth; expiration
29
inches; inspiration 36% inches
Respiration, rate of
16
Heart,
pulse rate 78
Right eye (Snellen) 20/15 ; corrected to 20/15 ; lens used spher
12. Vision:<
Left eye (Snellen) 20/20
;
corrected to 70/20
; lens used 25-==75gl.90
13. A. D. 15/15
Hearing:
A. S.
15/15
14. Urine examination:
Color amber
Reaction albaline
Specific gravity 1.030
Albumen absent
Casts
none
Leucocytes negative
Sugar absent
15. Do you recommend applicant for:
(a) General hospital service you
(b) Tropical service
16. Fill in name and number of base hospital, unit or detachment with which applicant is connected:
Army base hospital
Naval base hospital
Emergency detachment
Navy detachment
Hospital unit
Me. A.
M. D.
Date Ceptrial 26- 1920.
Address Teacher College
All questions MUST be answered; otherwise certificate will not be accepted at
headquarters.
To be forwarded to Chief Nurse of Unit or to the Local Committee Organizing
Detachment on Red Cross Nursing Service.
(SEE OTHER SIDE)
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"ocrText": "DMR29-N.E.D.\nTHE AMERICAN RED CROSS\nDEPARTMENT OF NURSING\nPhysical Examination\n1. Name of applicant\nAddress 238 Webster Street City East Boston State mease\nStella Goostray\n2. Age 33\nHeight Weight 122 (indoor clothes\n3. General physique ford.\n4. Tendency to disease, inherited or otherwise none.\n5. Previous history in regard to serious illness or surgical operation Typloid Fever 1916.\nComplicated with persumonia.\n6. Has she had rheumatism ? Following typleod no offand on for 6mos. 1916\n7. Has she at present or has she ever had hernia?\n8. Condition of teeth good Crounds - ( (nular - I licenseal\n9.\nCondition of feet Rt. foot arch flattered no meonvenence\n10. Abdomen and contained organs negative\n11. Chest and contained organs negative\nGirth; expiration\n29\ninches; inspiration 36% inches\nRespiration, rate of\n16\nHeart,\npulse rate 78\nRight eye (Snellen) 20/15 ; corrected to 20/15 ; lens used spher\n12. Vision:<\nLeft eye (Snellen) 20/20\n;\ncorrected to 70/20\n; lens used 25-==75gl.90\n13. A. D. 15/15\nHearing:\nA. S.\n15/15\n14. Urine examination:\nColor amber\nReaction albaline\nSpecific gravity 1.030\nAlbumen absent\nCasts\nnone\nLeucocytes negative\nSugar absent\n15. Do you recommend applicant for:\n(a) General hospital service you\n(b) Tropical service\n16. Fill in name and number of base hospital, unit or detachment with which applicant is connected:\nArmy base hospital\nNaval base hospital\nEmergency detachment\nNavy detachment\nHospital unit\nMe. A.\nM. D.\nDate Ceptrial 26- 1920.\nAddress Teacher College\nAll questions MUST be answered; otherwise certificate will not be accepted at\nheadquarters.\nTo be forwarded to Chief Nurse of Unit or to the Local Committee Organizing\nDetachment on Red Cross Nursing Service.\n(SEE OTHER SIDE)"
}