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D M R 29
THE AMERICAN RED CROSS
DEPARTMENT OF NURSING
Physical Examination
1. Name af applicant
ammi Laurie Williams
Address N.4. City Farms
City
3 awade State N.Y.
2. Age 39.
Height
68 tunder
Weight
173.
3. General physique Robust.
4. Tendency to disease, inherited or otherwise home
5. Previous history in regard serious illness surgical operation no history
to or
of operation or serious ullness
6. Has she had rheumatism ?
no.
7. Has she at present or has she ever had hernia? no
from them
8.
Condition of teeth fair has lost four or fire molers no brouble
9. Condition of feet normal
10. Abdomen and contained organs normal
11. Chest and contained organs
normal-
Girth; expiration
333/4
inches; inspiration
36
inches
Respiration, rate of
18.
Heart, pulse rate
78
Right eye (Snellen) normal
; corrected to
; lens used
12. Vision :
Left eye (Snellen) normal ; corrected to
; lens used
13. Hearing: A. D.
nermal
A. S.
nemal
14. Urine examination :
Color
show
Reaction
and
Specific gravity
1020
Albumen heg
Casts
neg
Leucocytes neg
Sugar neg
15. Do you recommend applicant for : - anything
(a) General hospital service.
City
OK
(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
Hany Say
M. D.
Date June 25.1918
Address
was week my
All questions MUST be answered; otherwise certificate will not be accepted at head-
quarters.
To be forwarded to Chief Nurse of Unit or to the Local Committee on Red Cross
Nursing Service.
(SEE OTHER SIDE)
A
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Document data
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"ocrText": "D M R 29\nTHE AMERICAN RED CROSS\nDEPARTMENT OF NURSING\nPhysical Examination\n1. Name af applicant\nammi Laurie Williams\nAddress N.4. City Farms\nCity\n3 awade State N.Y.\n2. Age 39.\nHeight\n68 tunder\nWeight\n173.\n3. General physique Robust.\n4. Tendency to disease, inherited or otherwise home\n5. Previous history in regard serious illness surgical operation no history\nto or\nof operation or serious ullness\n6. Has she had rheumatism ?\nno.\n7. Has she at present or has she ever had hernia? no\nfrom them\n8.\nCondition of teeth fair has lost four or fire molers no brouble\n9. Condition of feet normal\n10. Abdomen and contained organs normal\n11. Chest and contained organs\nnormal-\nGirth; expiration\n333/4\ninches; inspiration\n36\ninches\nRespiration, rate of\n18.\nHeart, pulse rate\n78\nRight eye (Snellen) normal\n; corrected to\n; lens used\n12. Vision :\nLeft eye (Snellen) normal ; corrected to\n; lens used\n13. Hearing: A. D.\nnermal\nA. S.\nnemal\n14. Urine examination :\nColor\nshow\nReaction\nand\nSpecific gravity\n1020\nAlbumen heg\nCasts\nneg\nLeucocytes neg\nSugar neg\n15. Do you recommend applicant for : - anything\n(a) General hospital service.\nCity\nOK\n(b) Tropical service\n16. Fill in name and number of base hospital, unit or detachment with which applicant is connected:\nArmy base hospital\n-\nNaval base hospital\nEmergency detachment\n-\nNavy detachment\n-\nHospital unit\nHany Say\nM. D.\nDate June 25.1918\nAddress\nwas week my\nAll questions MUST be answered; otherwise certificate will not be accepted at head-\nquarters.\nTo be forwarded to Chief Nurse of Unit or to the Local Committee on Red Cross\nNursing Service.\n(SEE OTHER SIDE)\nA"
}