John Andrews graduated with a doctor of medicine degree in the spring of 1916. Later that same year he was bound for China. Between graduation and leaving for China he successfully passed the medical board exam in Maryland. In order to legally practice medicine in China he needed to apply for a license there. What you see here is the “Registration” form showing he was accepted to practice medicine in China. It was probably issued in 1916 or 1917.
John and Dorothy Andrews later in life in the back yard of their home in Silver Spring, Maryland. Probably taken in the early 1970s.