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N
FORM 1193
REV. JULY 1941
AMERICAN RED CROSS
I
NURSING SERVICE
e
-
PHYSICAL EXAMINATION
e
(All questions must be answered by definite statements)
5
1. Name of applicant HELEN ALDINE McNUTT
Address 613 PARK
City WILLARD
State O HIO
D
2. Age 43
Height 5 FEET TINCHE SWeight
145 #
-
(feet and inches)
(pounds)
a
3. Family history
4. Past history: General health, operation, injury, any illnesses (Indicate dates) deputters x
,
Scarlet Fever in childhood no operations. tradered Pellence
e
5. General physique Well developed well wounded white female
(Rt. eye 20/29
(Rt. 20/
(Rt. name
6. Distant Vision: Without glasses
(Lt. eye 20/20
With glasses
Evidence of disease
(Lt.20/
Lt. now
Note: Actual vision should be determined on proper letters for 20 foot distant, as 20-20, 20-30, 20-100, etc.
Rt. ear28/20ft.
}
(Rt. name
7. Hearing: (Whispered voice)
Evidence of disease
(Lt. ear 79/20 ft.
(Lt. name
8. Teeth and gums: (Note abnormalities)
normal
Directions: Indicate as follows-
Right,
Applicant's
Left
Missing tooth
U8
3 4 5 6 7 8
Teeth:
Bridgework
L8 * 5 4 3 2 1 1 2 3 4 5 6 7 8
Crown
"Plate"-write out word to indicate plate.
9. Nose
and areco Throat abs Jousels removed
10. Neck: (Thyroid gland and other abnormalities) such Hepoil would two
masses
visable palpable Nech normal
11. Skeletal: (Bones, joints, muscles, and feet) normal
IS quacupeq ou
12. Thorax: Expiration 32%2 inches
Inspiration
35
inches
Respiration
20
a
per minute
Lungs to percussion and auscultation normal
Cardio-vascular system
normal
2)
Heart: Size apay heat learn ment to this
2
Murmurs name
6
JAN 2 1948
Pulse. 72 Blood pressure: Syst. 126
Dias. 84
5
(OVER)
8
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"ocrText": "3\nN\nFORM 1193\nREV. JULY 1941\nAMERICAN RED CROSS\nI\nNURSING SERVICE\ne\n-\nPHYSICAL EXAMINATION\ne\n(All questions must be answered by definite statements)\n5\n1. Name of applicant HELEN ALDINE McNUTT\nAddress 613 PARK\nCity WILLARD\nState O HIO\nD\n2. Age 43\nHeight 5 FEET TINCHE SWeight\n145 #\n-\n(feet and inches)\n(pounds)\na\n3. Family history\n4. Past history: General health, operation, injury, any illnesses (Indicate dates) deputters x\n,\nScarlet Fever in childhood no operations. tradered Pellence\ne\n5. General physique Well developed well wounded white female\n(Rt. eye 20/29\n(Rt. 20/\n(Rt. name\n6. Distant Vision: Without glasses\n(Lt. eye 20/20\nWith glasses\nEvidence of disease\n(Lt.20/\nLt. now\nNote: Actual vision should be determined on proper letters for 20 foot distant, as 20-20, 20-30, 20-100, etc.\nRt. ear28/20ft.\n}\n(Rt. name\n7. Hearing: (Whispered voice)\nEvidence of disease\n(Lt. ear 79/20 ft.\n(Lt. name\n8. Teeth and gums: (Note abnormalities)\nnormal\nDirections: Indicate as follows-\nRight,\nApplicant's\nLeft\nMissing tooth\nU8\n3 4 5 6 7 8\nTeeth:\nBridgework\nL8 * 5 4 3 2 1 1 2 3 4 5 6 7 8\nCrown\n\"Plate\"-write out word to indicate plate.\n9. Nose\nand areco Throat abs Jousels removed\n10. Neck: (Thyroid gland and other abnormalities) such Hepoil would two\nmasses\nvisable palpable Nech normal\n11. Skeletal: (Bones, joints, muscles, and feet) normal\nIS quacupeq ou\n12. Thorax: Expiration 32%2 inches\nInspiration\n35\ninches\nRespiration\n20\na\nper minute\nLungs to percussion and auscultation normal\nCardio-vascular system\nnormal\n2)\nHeart: Size apay heat learn ment to this\n2\nMurmurs name\n6\nJAN 2 1948\nPulse. 72 Blood pressure: Syst. 126\nDias. 84\n5\n(OVER)\n8"
}