1951-1952 Baptist Bible Institute Catalog

PHYSICIAN'S CERTIFICATE of APPLICANT'S HEALTH EXAMINATION BAPTIST BIBLE INSTITUTE 8273 HOUGH AVE. CLEVELAND 3, o ·HIO Date ............. .. .... . . . Name of Applicant Ears-Right. . . . . . . Left ...... . Nose... . . . . Throat ...... . Teeth. . . . . . Eyes. . . . . . Does applicant wear glasses? ..... . Reading only ...... Heart ...... I\·Iurmurs ...... Pulse ..... . Lungs ...................... ..... ...................... . P.M.H.: Chicken pox. . Measles. . Whooping cough. . Diphtheria .. Scarlet Fever ...... Infantile Paralysis ...... Pneumonia ..... . Is the applicant subject to sore throat?. . . . . . Common colds ..... . Headache. . . . . . Tuberculosis. . . . . . Ilheu:uatic Fe,·er ..... . Dysmenorrhea. . . . . . Is it necessary for the applicant to take any medications for any of the above conditions? If so s.tate Describe, if any, special weaknesses or limitations; abnormalities; ' injuries: ................................. ....... ....... . This is to certify that ......................................... . is mentally fit ( ) and physically fit ( ) for the demnnds of unfit ( ) unfit ( ) student life in The Baptist Bible Institute, 8273 Hough Ave., Cleveland 3, Ohio Signed ................................. ::\f. D. Addr ss .......... ........................... . . . . . . ... . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . Lie nse number ............. .... . -43 -