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“Number of certifioate upon which spplicant' RAMs BD YPOBTB woenovececeecereverernees The gim of the Executive order of June 38,1923, and of this examination thereunder is to obiain Information ag to the physical condition of appainiees io the classified evil service with a view ic promoting efficiency and malnimizing atcddenta and elaime under United Siates employees’ compensation laws. NOTES FOR EXAMINING PHYSICIAN. Weront,— Males, without clothing, and also in ordinary clothing without overeoat or hat (weigh twice); females, clothed but without wrap or hat. Ef overweight, slate whether due to bone and muscle or te fat. Hriasr.—Witheut boots or slioes; observe that no appliances are used to ineresae. The amination should include the following obyerrations, as to— 3. Eves-—Ptosis; discharge; corneal acar} pterygium. In-resording distant vision consider 20 feet ag normal and report all vision as a fraction with 20 feet as numerator and the smallest type read at 20 fect as denéminator. If glasses are:used, seeord for each eye the finding with and without ginsses.* 2. Kans. Evidence of middle aar-or mastoid digesse; condition of drums; discharge. In recording hearing, ‘record 20 feet. #a tiormal distance for conversational voice and record deviation from: vortial as fraction with 2) as denominator and actual distanee.as numerator. ; 3. Noss. Ability to blow through each nostril. Tf free, a apeculun esamination would net be indicated: 4,. Moori.--~Missing teeth, pyormhes, &. Tanoat-—Tonsils, hypertrophy or diseasc, 6. Tevsow.—~Presence of tumor in neck sad tremor, exophthalmos: nervous high-strung deposition, especially in women *. Heanr—Murnors. State whether functional. or organic. Hf valvular disease exists, state whether or sot it is fully. compensated. 8. Lowes.—It is necessary that the suseuiiatory ‘eough be used. Tuberculosis: f present, etate whether active or arrested, and if arrested your opinion as to haw Jong it ias been qilescant. Sputum to be exauined for tubercle baciill in all suspected GASES. 9. Ixeursan xives.—Hernia; no hernia, but impulse on coughing; ne hernis or tmpulse, bud albmormally large tings. “Any other hernia should be nated, and if present describe fully aud state whether it Is.rotained by well-ftting truss. IQ to 13. Scars, deformities, atrophies, prralyses, or ‘Rat foot of such austure as tu incapacitate or become aggravated by work or be later alleged as cansed by accident or ocedpation. By “dat foot", ac used in this form, is zheant a font with impaired function, the term being equivalent to "alien or misplaced arch”, an abricriud! comdition.. Trpaicnient of funetinn isthe potat tobenoted. ltis not intended that amall, insignificant blemishes which might be referred to as marke of identification be recorded. 14, ‘This entry should include symptoms and full history of any mental or nervour abnormality. if: Urinalysis to be made and blood pressure tobe taken when especially indicated, particularly in pereons over 40 when arteriosclerosis, nephritis, or Gabetes is suape Reeord, f taken—Urinalysie—Sp. gr, Blood pressure: Mm. Bg. apatolic._.. HE tachycardia is present, give pulse rate: Sitting ....c220.uc. Tmmediitely after exercise occ — ‘Tweminutes after ERNE AD AeA eee A ee pene eC Re pe RS ee ca eae Be ee ae Ge ee ne A ne ee ee ee ee re b Ee te Ea te Ae tea ran ne rn et en a ae Artin i Altumen . Sugar .. Ae ae ev Se EE GR SAE A NE EEA RR A RO MN A RN Re a A A ERA SEE SE a REE EME RE Ne Sk i ee WS CATR Cee ee eae AN en ee ete ee ee eg ~ 2 Nie at esa ea physician} werecs Meee i ag MALE MAE ILOS * Near vision. What ts thi longnst and the shortest distances at whiek | ean he reed by applicant; Pen each eye separataly, WHS he wiew of promocing bevtth. acd eiictency snd of solninising ancients somes Federal empliree, the teas . of ot te socom! suemuiive deparinan Linde pensent tetabtishmects baring & mecdival penwenwel wee diterted 4. mike : | Sasme af apal aad staple gees in the Federal shasied extrice ap maybe peauesad ty che s egreniod at kas athe Titles Reto thea, Thk Sr encbeg ort Mappteinoat the Bs ive andere of Bay 30 -and dane 16, TOSS (haecotivg cedar Bapincoher. 4, e8), danger A: Goaiion id Tinptie $7.2, Beamined for position in— Draper bent 2c nein cesta en neinartonne! Bead Wn cc ctitaenine een earn neeiviida chidieetine medina Au innate nwiatener ater enw Title of position rrtecaenenneerenamanctnwesenenenenmanitnnmnticmnntnnarcaantecantn tt U.S. CHVERN BERT PRINTING BFTIEE fe~—s900'