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Form 2071(November 1941)# UNITED STATES CIVIL SERVICE COMMISSION# CERTIFICATE OF MEDICAL EXAMINATIONApplicant must fill in dotted lines below to heavy lineBIRCH. D. O'NEAL 24. EVANS ST. BAINBRIDGE, GA.Male Jan 1913 MEDICAL(Department and bureau in which you are to be employed)Caralas Venezueber1. Have you any physical defect or disease or disability whatsoever? Yes   If answer is "yes" give details: Kelaine, Asthma, appendectomy.   42 3/4 inches 188 pounds 180 pounds Males, with and without clothing; females, clothed, but without wrap or hat.PHYSICIAN SHOULD FILL IN THE FOLLOWINGItems checked (√) were examined and found normal. Deviations from normal are noted. (See instructions on reverse side,numbered to correspond with items below.)1. Eyes: Distant vision: Without glasses: Right: 20 Left: 20 With glasses if worn: Right: 20 Left: 20   Near vision:   What is the longest and the shortest distance at which the following specimens of Jaeger No. 1 and Jaeger No. 2 can be read by the applicant? If No. 1 is read with ease, No. 2 need not be given. Test each eye separately.With the view of promoting health and efficiency and of minimizingabsenteeism among Federal employees, the heads of the several executivedepartments and independent establishments having a qualified medicalstaff are directed to make such physical examinations of applicants for(Jaeger No. 1)and employees in the Federal classified service as may berequested by the Civil Service Commission or its authorizedrepresentative.This order will supplement the Executive orders of May 29and June 18, 1921 (Executive order, September 4, 1921).(Jaeger No. 2)|                                                    | Without glasses | With glasses, if used || -------------------------------------------------- | --------------- | --------------------- || I.  U in. to 18 in.                                |                 | I.  in. to in.        || II.  U in. to 18 in.                               |                 | II.  in. to in.       || III.  U in. to 18 in.                              |                 | III.  in. to in.      || IV.  U in. to 18 in.                               |                 | IV.  in. to in.       || Jaeger No. 1                                       | Without glasses | With glasses, if used || I.  U in. to 18 in.                                |                 | I.  in. to in.        || II.  U in. to 18 in.                               |                 | II.  in. to in.       || III.  U in. to 18 in.                              |                 | III.  in. to in.      || IV.  U in. to 18 in.                               |                 | IV.  in. to in.       || Evidence of disease or injury: Right: No  Left: No |                 |                       |Color vision: Is color vision normal when Ishihara or other color plate test is used? YesIf not, can applicant pass lantern, yarn or other comparable test?2. Ears: (Consider denominators indicated here as normal. Record as numerators the greatest distance heard.) Ordinary conversation: Right ear 20 Left ear 20 Evidence of disease or injury: Right ear No Left ear No3. Nose, sinus disease, etc. √4. Mouth and throat √5. Gastro-intestinal √6. Thyroid (especially in women) √7. Heart and blood vessels √Blood pressure: Mm. Hg. systolic 128 Mm. Hg. diastolic 80Is organic heart disease present? No If organic heart disease is present, is it fully compensated? —8. Lungs: Right — Left —History of tuberculosis? No If so, has the disease been arrested for at least 1 year? —If there is a history of tuberculosis, is any type of collapse therapy being received at present? (If so, give full details under remarks.) —9. Hernia: None   If present, is it supported by a well-fitting truss?10. Varicose veins None    Varicocele (see note 10 on reverse side) None11. Foot: Is flat foot present? No Degree of impairment of function (None, slight, moderate, severe)12. Deformities, atrophies, and other abnormalities, diseases, or defects not included above: Ent recurence (4942)13. Scars of serious injury or disease: appendectomy (Mc Burney)14. Nervous system (see note 14 on reverse side) No    Is there any history of a "nervous breakdown"? No    If hospitalized, give name of hospital and location —15. (a) Urinalysis (see reverse side) No (b) Venereal disease No16. Obtain from applicant statement of disabilities, past and present, give diagnosis and your comments under "Remarks."17. Does Veterans Administration recognize service-connected disability in this case? No If "yes," cover in your comments.18. Has examinee ever received disability retirement from U. S. Civil Service Commission? No16-1003-1 This certificate is to be returned to the official requesting the examination [OVER]