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Created by general-english-image-caption-blip on 2025-05-29

a photograph of a document with a document with a picture of a man in a suit

Created by general-english-image-caption-blip-2 on 2025-07-07

a document with a black background and white text

Created by gpt-4o-2024-11-20 on 2025-06-11

This image shows an official blank form, likely used for a school application or enrollment process that also includes a section for medical examination. It is divided into two main sections:

• Left side:

  • It begins with questions such as: "By whom recommended?" "Where did you read or hear of our School?" and "What do you intend to do after graduation?"
  • There's also a large space labeled "REMARKS" for additional notes or comments.

• Right side:

  • The top portion is titled "PHYSICAL EXAMINATION," listing medical criteria such as vaccinations, hearing, sight, lungs, heart, and general conditions of health. Questions include whether the applicant has any deformity, hereditary, or acquired disease.
  • Below this section is a space for "GENERAL REMARKS."
  • At the bottom, there is a declaration mentioning "The foregoing examination has been made by Dr. ____," with spaces for the physician’s name, residence, and signature.
  • There are options for outcomes with "Accepted," "Rejected on account of," and "Postponed" fields.

The form is blank, meant to be filled out, and is printed on pale paper, with dotted lines indicating space for responses.

Created by gpt-4o-2024-08-06 on 2025-06-11

The image shows a form that appears to be part of an application or assessment document. On the left side, there are a few questions related to a school application, such as:

• "By whom recommended..."
• "Where did you read or hear of our School?"
• "What do you intend to do after graduation?"

Below these questions, there is a section labeled "REMARKS:" with space for additional notes or comments.

On the right side of the form, there is a "PHYSICAL EXAMINATION" section with fields for various health-related aspects, including:

• "Vaccinated..."
• "Sight..."
• "Hearing..."
• "Lungs..."
• "Heart..."
• "General conditions of Health..."

There are also questions regarding any deformities or hereditary/acquired diseases of the applicant.

At the bottom of the form, there are sections for indicating the outcome of the examination, with options like "Accepted...", "Rejected on account of...", or "Postponed...".

Finally, there is a line for the signature of the physician who conducted the examination, along with a statement confirming the accuracy of the examination results.

Created by anthropic.claude-3-haiku-20240307-v1:0 on 2025-06-17

The image appears to be a physical examination form. It contains sections for recording information about the applicant's vaccination status, hearing, sight, heart, lungs, and general health conditions. There are also sections for remarks and the physician's signature, indicating this is a medical evaluation document.

Created by us.anthropic.claude-3-5-sonnet-20241022-v2:0 on 2025-06-17

This appears to be a historical medical or school examination form. The document includes several sections for recording information, including:

• A recommendation section at the top
• Questions about where the applicant heard about the school and their post-graduation plans
• A "Physical Examination" section with fields for recording:
  • Vaccination status
  • Hearing
  • Sight
  • Heart
  • Lungs
  • General health condition
• Questions about physical defects and hereditary diseases
• Sections for "Remarks" and "General Remarks"
• A bottom portion for the examining physician's information and signature
• Final status options including "Accepted," "Rejected," and "Postponed"

The form appears to be printed on aged paper and uses formal, traditional typeface and formatting typical of older administrative documents. It was likely used as part of an admission or enrollment process for some type of institution or school.

Created by us.meta.llama3-2-11b-instruct-v1:0 on 2025-06-11

The image presents a vintage medical examination form, characterized by its off-white color and black text. The form is divided into two main sections: "By whom recommended" and "Physical Examination."

• By whom recommended
  • This section contains three lines for the recommender's information, including their name, address, and occupation.
  • The first line is designated for the recommender's name, while the second line is for their address, and the third line is for their occupation.
• Physical Examination
  • This section includes several lines for the examiner's observations, including:
    • Vaccinated
    • Sight
    • Heart
    • General conditions of Health
    • Has applicant any deformity of any part or any region of the body?
    • Has the applicant any hereditary or acquired disease?
  • The examiner's signature is required at the bottom of this section.

The form also includes a section for remarks, which is blank. Additionally, there is a line for the examiner's name and another for the date of the examination. Overall, the form appears to be a standard template used for medical examinations in the past.

Created by us.meta.llama3-2-90b-instruct-v1:0 on 2025-06-11

The image shows a medical examination form, likely from the early 20th century. The form is divided into two sections: "Physical Examination" and "General Remarks."

Physical Examination Section:

• This section contains several blank lines for the doctor to fill in their findings during the physical examination.
• The categories include:
  • Vaccinated
  • Sight
  • Heart
  • General conditions of Health
  • Has applicant any deformity of any part or any region of the body?
  • Has the applicant any hereditary or acquired disease?

General Remarks Section:

• This section also has several blank lines for the doctor to provide additional comments or observations about the applicant's health.
• The categories include:
  • The foregoing examination has been made by Dr.
  • Residing
  • And the answers are a correct statement of the result of such examination.
  • Signature of Physician

Other Sections:

• There are two other sections on the form:
  • "Remarks:" - This section is blank and appears to be for any additional comments or notes from the doctor.
  • "By whom recommended" - This section is also blank and may be for the name of the person who recommended the applicant for the examination.

Overall, the form provides a comprehensive overview of the applicant's physical health and any potential health issues that may affect their ability to perform certain tasks or activities.

Created by amazon.nova-lite-v1:0 on 2025-06-09

The image appears to be a physical examination form for a school applicant. The form is divided into two main sections:

1. Personal Information: This section asks about the applicant's name, address, and the person who recommended them for the school. It also inquires about where the applicant heard about the school and their plans after graduation.

2. Physical Examination: This section is divided into several subsections, each focusing on a different aspect of the applicant's health. The subsections include:

• Vaccinations: This section asks about the applicant's vaccination status, including whether they have been vaccinated for specific diseases.
• Hearing and Vision: This section asks about the applicant's hearing and vision, including whether they have any impairments or require corrective lenses.
• Heart and Lungs: This section asks about the applicant's heart and lung health, including any history of heart or lung conditions.
• General Health: This section asks about the applicant's overall health, including any hereditary or acquired diseases.
• Deformities: This section asks about any physical deformities or abnormalities the applicant may have.
• Remarks: This section provides space for the physician to make any additional remarks or observations about the applicant's health.

The form also includes a section for the physician's signature and the date of the examination. The form is designed to gather comprehensive information about the applicant's health and fitness for enrollment in the school.

Created by amazon.nova-pro-v1:0 on 2025-06-09

The image shows a form that is likely used for a physical examination. It has two sections, one for the physical examination and the other for general remarks. The physical examination section includes questions about the applicant's vaccination status, hearing, sight, lungs, heart, and general health conditions. The general remarks section includes questions about any deformities, hereditary or acquired diseases, and the applicant's future plans after graduation. The form also includes spaces for the physician's signature and the date of the examination.

Created by gemini-2.0-flash on 2025-05-28

Here's a description of the image:

The image shows an old form, likely for school admission. It's divided into sections. On the left, there are questions about how the applicant heard about the school and their plans after graduation, as well as space for remarks. On the right, there's a section for a physical examination, including fields for vaccination, sight, hearing, lungs, heart, general health, and questions about deformities or hereditary/acquired diseases. At the bottom, there's a statement that the examination was made by a doctor, along with space for the doctor's address and signature. The form has an aged, antique appearance.

Created by gemini-2.0-flash-lite on 2025-05-28

The image is a form, possibly a document for admission or application. The form is divided into several sections and contains fill-in-the-blank spaces and questions.

Here's a breakdown of the sections:

• Top-Left: Contains questions such as "By whom recommended...", "Where did you read or hear of our School?", and "What do you intend to do after graduation?". It also has a space for "REMARKS:".
• Top-Right: Labeled "PHYSICAL EXAMINATION:" and includes spaces to fill in information regarding "Vaccinated," "Sight," "Heart," "General conditions of Health," "Hearing," and "Lungs." There are also questions about deformities and hereditary/acquired diseases. A space for "GENERAL REMARKS" is also available.
• Bottom-Left: Includes spaces for the decision on the applicant, whether "Accepted," "Rejected on account of...", or "Postponed".
• Bottom-Right: Includes fields like "The foregoing examination has been made by Dr...","Residing," "And the answers are a correct statement of the result of such examination." and "Signature of Physician...".

The form appears to be designed to gather information about a potential student, including their background, medical condition, and the institution's decision regarding their admission. The vintage style of the text and layout hints at an older time.

Created by us.mistral.pixtral-large-2502-v1:0 on 2025-06-06

The image appears to be a form, likely a medical examination form, used for evaluating individuals, possibly for educational or employment purposes. The form is divided into several sections:

1. Recommendation and Educational Background:

   • A section asking for the name of the person who recommended the applicant.
   • A question about where the applicant read or heard about the school.
   • A question about the applicant's intentions after graduation.

2. Physical Examination:

   • This section is designed to record the results of a physical examination. It includes fields for:
     • Vaccination status.
     • Hearing.
     • Sight.
     • Lungs.
     • Heart.
     • General conditions of health.
     • Presence of any deformities or abnormalities in any part or region of the body.
     • Presence of any hereditary or acquired diseases.

3. General Remarks:

   • A section for any additional remarks or notes.

4. Examination Details:

   • A statement indicating that the examination has been conducted by a doctor, with a space for the doctor's name.
   • A section for the residence of the applicant.
   • A declaration that the answers provided are a correct statement of the examination results.
   • A space for the signature of the physician.

5. Decision:

   • Options for the decision made based on the examination:
     • Accepted.
     • Rejected on account of (with a space to specify the reason).
     • Postponed.

The form is structured to gather comprehensive information about the applicant's health and background, ensuring that they meet the necessary criteria for acceptance into the school or program.

Created by Qwen/Qwen2.5-VL-7B-Instruct on 2025-07-16

This image appears to be a form used for a physical examination and application process, possibly for a school or organization. Here's a breakdown of the different sections:

1. Personal Information Section:

   • "By whom recommended." This field is for noting the person who recommended the applicant.
   • "Where did you read or hear of our School?" This field is for the applicant to provide information on how they learned about the school.
   • "What do you intend to do after graduation?" This field is for the applicant to state their future plans after completing their education.

2. Physical Examination Section:

   • The form includes fields for the results of a physical examination, including:
     • Vaccinated
     • Hearing
     • Sight
     • Lung
     • Heart
     • General conditions of Health
   • There are also questions to check for any deformity or hereditary/acquired diseases in the applicant.

3. Remarks Section:

   • This section is reserved for additional notes or comments related to the application or the physical examination.

4. General Remarks Section:

   • This section is for the physician to provide any additional remarks or observations about the applicant's health and condition.

5. Conclusion Section:

   • The form notes that the physical examination was conducted by a physician.
   • There are fields for the physician to sign and indicate the conclusion of the examination, which could be "Accepted," "Rejected on account of," or "Postponed."

The form appears to be designed for a systematic evaluation of the applicant's health and background, likely as part of an application process for a school or program requiring both a physical and a personal evaluation.

Created by Qwen/Qwen2.5-VL-72B-Instruct on 2025-07-16

This image is a document, likely an application or admissions form for a school or educational institution. It includes sections for personal information and a physical examination.

On the left side, there are fields for:

• By whom recommended
• Where did you read or hear of our School
• What do you intend to do after graduation
• Remarks

On the right side, there is a section labeled "PHYSICAL EXAMINATION" with fields for:

• Vaccinated
• Hearing
• Sight
• Lungs
• Heart
• General conditions of Health
• Has applicant any deformity of any part or any region of the body
• Has the applicant any hereditary or acquired disease
• General Remarks

At the bottom, there are fields for:

• The signature of the physician who conducted the examination
• The resident
• The acceptance, rejection, or postponement of the application
• The signature of the physician.