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FORM 1193
REV. 10-26-38
AMERICAN RED CROSS NURSING SERVICE
PHYSICAL EXAMINATION
(Follow instructions at end of form in answering all questions)
1. Name of applicant Betty hou Wilson
Address 3212 STacKTon ST. City Richmond
State Uirginia
9 over max
2. Age
22
Height 571/2"
Weight 176 33 00.00 ideal
3. Family history neg.
4. Past history: General health, operation, injury, any illnesses Pegaridal yet reanoned
nisudia
5. General physique rebust
appendicting torman 1937
6.
Eyes: Pupils; Right eye; Distant vision 2%/20 Corrected to
Lens used
Left eye; Distant vision 20/70 Corrected to
Lens used
NOTE: - Actual vision should be determined on proper letters for 20 foot distant, as 20-20, 20-30, 20-100, etc.
If glasses are worn state correction.
7. Ears: may
8.
Teeth and gums: (note abnormalities) and
NOTE:-Check chart on other side of blank.
9. Throat normal
10. Neck: (Thyroid gland abnormalities) neg
and other
11. Skeletal: (Bones, joints, muscles and feet) normal
12. Thorax: Expiration 36.4
inches
Inspiration 39
inches
Respiration
18 per minute
Lungs to percussion and auscultation normal
Cardio-vascular system normal
Heart: Size normal
Murmurs more
Pulse 78
Blood pressure: S 130
D 86
(Over)
/
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"ocrText": "FORM 1193\nREV. 10-26-38\nAMERICAN RED CROSS NURSING SERVICE\nPHYSICAL EXAMINATION\n(Follow instructions at end of form in answering all questions)\n1. Name of applicant Betty hou Wilson\nAddress 3212 STacKTon ST. City Richmond\nState Uirginia\n9 over max\n2. Age\n22\nHeight 571/2\"\nWeight 176 33 00.00 ideal\n3. Family history neg.\n4. Past history: General health, operation, injury, any illnesses Pegaridal yet reanoned\nnisudia\n5. General physique rebust\nappendicting torman 1937\n6.\nEyes: Pupils; Right eye; Distant vision 2%/20 Corrected to\nLens used\nLeft eye; Distant vision 20/70 Corrected to\nLens used\nNOTE: - Actual vision should be determined on proper letters for 20 foot distant, as 20-20, 20-30, 20-100, etc.\nIf glasses are worn state correction.\n7. Ears: may\n8.\nTeeth and gums: (note abnormalities) and\nNOTE:-Check chart on other side of blank.\n9. Throat normal\n10. Neck: (Thyroid gland abnormalities) neg\nand other\n11. Skeletal: (Bones, joints, muscles and feet) normal\n12. Thorax: Expiration 36.4\ninches\nInspiration 39\ninches\nRespiration\n18 per minute\nLungs to percussion and auscultation normal\nCardio-vascular system normal\nHeart: Size normal\nMurmurs more\nPulse 78\nBlood pressure: S 130\nD 86\n(Over)\n/"
}