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ea ie x Par ear ean * « unten UfATES CIVIL SERVICE COMMISSION CERTIFICATE OF MEDICAL EXAMINATION UNDER EXECUTIVE ORDER, SEPT. 4, 1924. APPLICANT MUST FRI eee, TANES BELOW. ‘TO HEAVY LINE} . ‘ ae att athe 2. eet : Rolled print, right forefinger Sea PO e tne Renin ae. “ghee Car sae GOI Beat. aonansnieiionounvdenerareen RONEN AEA RE B (Printer be taken $9 identity person RIO Call wate bed. Medd, Laks | a =e Ae va (Date af birth) What emunlzntion did pins take? vronenn Bit gibeestiny E EEO BEI Sec is. what Dxpartmient and Beress a are. Jou to be employed? a vA cee ae Ad Dees Ra what Qty er Town are on ia be-eanplo at Yirk, ~ f : mien a CLAN PO! f Gtnteus the examining phyaician can { [ ' (PETSICIAN SHOULD iL LN HE FOLLOWING} ce the ms Thee at ral ibe pergon Ox at nee, Sh ew inches. « ft J Aaa pounds. : wavacavarsoe aeaceene pounds 7 idle or stamp pa moo be mass) (ee sbt, without shoes} (Waeat. is elathings ight, wit ; ennnen . Males, without clothing; females, clothed but without wrap or-ha Fema checked (y) were ezemined and found normal. Deviations jram ermal ercnoted, (Sea tnatruetions on back of sheet} 1, Eyes: Por distance: Without glasses: Righ {Near vision. must be veported in space Evidence of diseass or injurv: Right Colur vision Method of testing color visiow . Ears: (Consider denominators ing) gre AS ROTHimiemerd as mumerstors the athual distance heard.) Ordinary conversation: Right oa Left ear _ - senesced Exidesce of cisense or injury: Right ear 12 & Thyroid fespecially in women . %. Heart . : TPorganic heart disenge ig avaencnieaoy : present, is Hifully compensated &. Lunges: Rig If history of tuberculosis, 9. Inguinal rings (cen only}: 10. “Varicose veld Nevevaesnatteasancnevetecenentamerens Waridoosle ; eee rr wact slats lomation and depres} : . H. Flat foot § menenemnnnnnvanie aunwneayncntwnwateatavavensen nines es ; ae tit “Yeas state extent. of impsirment of fanctic! 2: Deformities, atrophies, and other abnormalities, digggses or defecta not included ¢ 1S. Urinslysis ¢ isee over} _ Venerest disease - 16. Has applicant ever received , ; Bllowante, retired par, or training because of disabitity received while in “pallitary or havsl eervicgg, Yes”, deseriba disability and state whether present now Wc c-ccceereser ernoware a Tv. Is my opinion, applicant ia capable of performing duties involvi 21 Te Bad, Lo Angel OOM en Publi cm ‘ Sd tbe Fodor Gog Surgeon ts ‘Ss physical exertion. ag “i Federal pmmination) {Te and Bravicl winral msdical vere) *For males, to bs taken only wpoon special written requed of the official ordering examination. ; ra . This report is te be returned to the official of the U. 8. Civil Service Commission request ng the examination | 3882.