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K M R 29 THE AMERICAN RED CROSS 0 NURSING SERVICE e Physical Examination 1. Name of applicant Address 4186 th Gity State Kausas Kanig Willine 2. Age 30 Sleader Height 5 fast beun Weight 118 lb 3. General physique 4. Tendency to disease, inherited or otherwise none char she knows of 5. Previous history in regard surgical operation no operalism to serious illness or no serrous allness 6. nor Has she had rheumatism? no 7. Has she at present or has she ever had hernia? 8. Condition of teeth good condlem 9. Condition of feet no blat normal 10. Abdomen and contained organs 11. Chest and contained organs normal Girth; expiration 26'11 inches; inspiration 31 inches Respiration, rate of 2v Heart, pulse rate 78 Right eye (Snellen) 20120 ; corrected to ; lens used 12. Vision: Left eye (Snellen) 20120 ; corrected to ; lens used 13. Hearing: A. D normal A. S. Noral 14. Urine examination; Color Shaw Reaction acid Specific gravity $016 Albumen They Casts they Sugar Ney Leucocytes May 15. Do you recommend applicant for: CHT mill serr M a / only (a) General hospital service yrs mee accept service (Hovi (b) Tropical service 16. Fill in name and number of base hospital, unit or detachment with which applicant is connected: Army base hospital U Naval base hospital Emergency detachment Navy detachment 5 Hospital unit FM Rour 18 Lernt mRs M. D. 0 Date All July 2019 questions MUST be Address Rause 1201 City Referr m answered; otherwise certificate will be accepted headquarters. not at To be forwarded to Chief Nurse of Unit or to Committee Organizing Detachment. EH, 5-18. 2 M.

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    "ocrText": "K\nM R 29\nTHE AMERICAN RED CROSS\n0\nNURSING SERVICE\ne\nPhysical Examination\n1. Name of applicant\nAddress 4186 th Gity State Kausas\nKanig Willine\n2. Age 30\nSleader\nHeight 5 fast beun\nWeight 118 lb\n3. General physique\n4. Tendency to disease, inherited or otherwise none char she knows of\n5. Previous history in regard surgical operation no operalism\nto serious illness or\nno serrous allness\n6. nor\nHas she had rheumatism?\nno\n7. Has she at present or has she ever had hernia?\n8. Condition of teeth\ngood condlem\n9. Condition of feet\nno blat normal\n10. Abdomen and contained organs\n11. Chest and contained organs\nnormal\nGirth; expiration 26'11\ninches; inspiration 31\ninches\nRespiration, rate of 2v\nHeart, pulse rate\n78\nRight eye (Snellen) 20120\n; corrected to\n; lens used\n12. Vision:\nLeft eye (Snellen) 20120\n; corrected to\n; lens used\n13. Hearing: A. D normal\nA. S. Noral\n14. Urine examination;\nColor Shaw\nReaction acid\nSpecific gravity $016\nAlbumen They\nCasts they\nSugar Ney\nLeucocytes May\n15. Do you recommend applicant for:\nCHT\nmill serr M a / only\n(a) General hospital service yrs mee accept service (Hovi\n(b) Tropical service\n16. Fill in name and number of base hospital, unit or detachment with which applicant is connected:\nArmy base hospital\nU\nNaval base hospital\nEmergency detachment\nNavy detachment\n5\nHospital unit\nFM Rour 18 Lernt mRs M. D.\n0\nDate All July 2019 questions MUST be\nAddress Rause 1201 City Referr m\nanswered; otherwise certificate will be accepted headquarters.\nnot at\nTo be forwarded to Chief Nurse of Unit or to Committee Organizing Detachment.\nEH,\n5-18. 2 M."
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