Health Department
Springfield, Mass.
Medical Inspection of Schools
Physical record of
age
State school year
Diphtheria Measles Mumps
in which pupil has had
Pertussis
Scarlet Fever
Date of first examination.
191
, in
School.
5
6
9
SCHOOL YEAR
2
3
4
8
1
7
Mo.
Date of examination
Y=Yes
Ds
N-No
Grade
G Good
Ft
..
In
-
Height
F-Fair
Weight
P-Poor
O-Opera-
tion
Chest measu
at rest
Vaccination
Use code
Nutrition
numbers
for diseases.
Anemia
Enlarged glands
f tonsils or
adenoids re-
moved indi-
Orthopedic defect
cate by O.
Nervous disease
Pulmonary disease
Cardiac disease
Teeth (G. F. P.)
Enlarged Tonsils
Adenoids
Vision
Hearing
Mentality
Remarks
s. I, 16
