17. Any form of fits?

18. Heart disease or varicose veins?

19. Is she subject to any functional disturbance?

* * * * *

I have on the day of 191 seen and
examined and
hereby certify that she is apparently in good health, that she
is not labouring under any deformity, and is, in my opinion,
both physically and mentally competent to undertake duty in
a Military Hospital, and is [*]A. Fit for General Service.
B. Fit for Home Service only.
C. Unfit.

_Date (Signed)
Address_

[Footnote *: Kindly delete categories which do not apply.]




* * * * *


Reference No.: J.W. 19c.