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OCR
ZI
et
ar
a
I
E
C
12. Abdomen and pelvis: (condition of wall, scars, herniae, and abnormality of viscera)
N
O
Circumference of abdomen at umbilicus 28 meher
negative
M
13. Urinalysis: Sp. Gr. 1012 Albumin neme Sugar nine Microscopiçal
rs.
Anoccasional squamus epithelial cell
F
1
N
14. Nervous system: (note organic or functional disorders)
e
Aug 1933
gank
15. Has the applicant been recently immunized against, Smallpoxmsgysse!Typhoid. 1935
Successfully
16. Remarks on abnormalities not otherwise noted or sufficiently described on this
blank no alnumatilies
a
6
CP.,
Is
the applicant fit to perform active duty (Military, Disaster, etc.?) yes
If not, state type of duty she is physically fitted to perform
Ethel Deliven M.D.
Date
Nov. 2 4,1936
Examiner
s
6
7
8
9
10
"
12
13
14
IS
y
y
P
n
A
17
18 19 20 21 22 23 24 25 26 27 28 29 30 31
32
Indicate missing teeth by "X", bridge work by C
crowns by
plates by word
"plate".
All questions MUST be answered; otherwise certificate will not be accepted at Head-
quarters. To be forwarded to the Local Committee on Red Cross Nursing Service.
1.
Be sure that all items are filled in before forwarding. Make definite statements in all instances.
2. Give age in years, height in inches, weight in pounds.
11. Chest measurements should be in total inches.
is
8,
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