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REPORT OF PHYSICAL EXAMINATION (See AR 40-100 and 40-105) Instructions Unless otherwise prescribed. this form will be used tor 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 if required. 1. Madley Gertrude (Last name) (First name) (Middle initial) (Serial number) 2 Civilian applicant for apointment Age 49 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 8 Last series October 1940 ,19 5. Date of last smallpox vaccination October 1940 Type of reaction Immune 6. Other vaccination or immunity tests None 7. Medical history 3 Usual childhood diseases Influenza 1918 No history of Asthma, Hay fever or Rhe umati 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# 3 correctible to J# by 4 (Jaeger type) Left J# 2 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 11. Teeth Right (Examinee's) Left 7 6 3 2 1 1 2 3 4 X)8 Indicate: Restorable carious teeth by o : nonrestorable carious teeth by / missing natural teeth by X. 16 15 12 11 10 9 9 10 16 Remarks, including other defects None Classification IV Prosthetic dental appliances Serviceable 12. Posture Good Figure Medium Frame Medium (Excellent, good, fair, bad) (Slender, medium, stocky, obese) (Light, medium, heavy) 13. Temperature Height 67 inches. Weight134.pounds. Chest Rest 32 inches inspiration 34 inches expiration 31 inches. Abdomen 33 inches. 14, Cardiovascular system : Heart Normal Blood pressure : S 140 D. 85 Pulse : Rate-Sitting 90 Immediately after exercise 105 Two minutes after exercise 84 Character Full and regular Arteries Normal Varicose veins None 15. Respiratory system Normal 16. X-ray of chest 8 Negative 17. Skin and lymphatics Normal Endocrine system Normal 18. Bones, joints, and muscles Normal Feet Normal 19. Abdominal viscera Normal 20. Hernia None Hemorrhoids None 1 Appointment. promotion. retirement. annual. active duty, special. 2 Regular Army : National Guard Officer's Reserve Corps : Reserve Officer's Training Corps. 3 If annual physical examination, record only for past year. 4 If 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. 7 If rejected for appointment in Regular Army because of malocclusion send plaster models to the Surgeon General. 8 Required for candidates for commission. .D., A.G FORM REPRODUCED HO. 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 tor 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 if required.\n1. Madley\nGertrude\n(Last name)\n(First name)\n(Middle initial)\n(Serial number)\n2 Civilian applicant for apointment\nAge\n49\nYears of service\n(Grade)\n(Organization and arm or service)\n(Nearest birthday)\n(Whole number only)\n3. Nature of examination 1 Appointment\nComponent of Army 2 Army of U.S.\n4. Typhoid vaccination. No. series completed\n8\nLast series\nOctober 1940\n,19\n5. Date of last smallpox vaccination October 1940\nType of reaction\nImmune\n6. Other vaccination or immunity tests None\n7. Medical history 3\nUsual childhood diseases\nInfluenza 1918\nNo history of Asthma, Hay fever or Rhe umati fever\n8. Eyes Normal\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#\n3\ncorrectible to J#\nby 4\n(Jaeger type) Left J#\n2\ncorrectible to J#\nby 4\nRefraction 5 (under cycloplegic) : Right\nNot done\nLeft\nNot 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 Normal\n11. Teeth\nRight\n(Examinee's)\nLeft\n7 6\n3\n2\n1\n1\n2\n3\n4\nX)8\nIndicate: Restorable carious teeth by o : nonrestorable carious\nteeth by / missing natural teeth by X.\n16\n15\n12\n11\n10\n9\n9\n10\n16\nRemarks, including other defects None\nClassification IV\nProsthetic dental appliances\nServiceable\n12. Posture\nGood\nFigure\nMedium\nFrame\nMedium\n(Excellent, good, fair, bad)\n(Slender, medium, stocky, obese)\n(Light, medium, heavy)\n13. Temperature Height 67 inches. Weight134.pounds. Chest Rest 32 inches inspiration 34 inches\nexpiration 31 inches. Abdomen 33 inches.\n14, Cardiovascular system : Heart Normal\nBlood pressure : S 140\nD.\n85\nPulse : Rate-Sitting\n90\nImmediately after exercise 105\nTwo minutes after exercise 84\nCharacter\nFull and regular\nArteries\nNormal\nVaricose veins\nNone\n15. Respiratory system Normal\n16. X-ray of chest 8\nNegative\n17. Skin and lymphatics\nNormal\nEndocrine system\nNormal\n18. Bones, joints, and muscles\nNormal\nFeet\nNormal\n19. Abdominal viscera\nNormal\n20. Hernia\nNone\nHemorrhoids\nNone\n1\nAppointment. promotion. retirement. annual. active duty, special.\n2 Regular Army : National Guard Officer's Reserve Corps : Reserve Officer's Training Corps.\n3\nIf annual physical examination, record only for past year.\n4\nIf\nannual 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.\n7 If rejected for appointment in Regular Army because of malocclusion send plaster models to the Surgeon General.\n8\nRequired for candidates for commission.\n.D., A.G FORM\nREPRODUCED\nHO. S.O.S. E.T.O."
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