‘Released under the John F. Kennedy Assassination Records Collection Act of 1992 (44 USC 2107 Hote). DATE: 11-14-2017 JFK Assassination System Date: 5/27/201 Identification Form Agency Information AGENCY:. FBI RECORD NUMBER: = 124-10132-10136 RECORD SERIES: HQ AGENCY FILENUMBER: 67-494012-224 Document Information ORIGINATOR: FBI FROM: KC TO: TITLE: \ DATE: — 10/13/1978 PAGES: 11 SUBJECTS : ; JAMES P. HOSTY JR. DOCUMENT TYPE: PAPER, TEXTUAL DOCUMENT CLASSIFICATION: — Unclassified RESTRICTIONS: 3 CURRENT STATUS: — Redact DATE OF LASTREVIEW: — 10/06/1998 OPENING CRITERIA: INDEFINITE COMMENTS : MED RPT, INC FD-300, MED SLIPS, CARDIOGRAM, EXAM v9.1 2 | Docld: 322784558 Page 1
Released under the John F. Kennedy Assassination Records Collection Act of DATA torkts2017 3 ws Revised April 1968 : ° nd ( * , General Services Administration C. ° . ue — ——- “REPORT OF MEDICAL EXAMINATION "Inger. cacy fomm. on Medical Records FEMICLO1- 11.809-3 * 2. GRADE AND COMPONENT OR POSITION ? LAST“ NAME FIRST NAME—MIDOLE NAME Tues Pe E-ADD ES: xin street or city or town, State and ZIP Code) rms EN — 1992 (44 USC 2107 Hote}. 3. IDENTIFICATION NO. 7BP 6. DATE OF EXAMINATION (3 Oet- (tS MSS COR “5. E6E6QAOS "7. SEX 8 RACE" re 9. TOTAL YEARS GOVERNMENT SERVICE CIVILIAN “52. 7 10. AGENCY - ee Fe 16. OTHER INFORMATION Sat ING FACILITY OR EXAMINER, AND ADDRESS . EXAM 11. ORGANIZATION UNIT . | - Kansas. CME 14. NAME, RELATIONSHIP, AND AQDRESS OF NEXT, OF KIN, -~ tHosTy * a 1PE) “ N7. RATING OR SPECIALTY TIME IN THIS CAPACITY (Total) NOTES. (Describe every abnormality in detail. comment. CLINICAL EVALUATION eck each item in appropriate col- umn, enter ‘'NE"' it not evaluated. 18. HEAD. FACE. NECK. AND SCALP 19. NOSE ’ NOR- 1-207 SINUSES *.- tee a tees 21. MOUTH AND THROAT -2-e 7 : (Int. & ert. canals) (Auditory 7 . 7. Qh 22. EARS- GENERAL acuity under items\70 and 71) _| ~ .¢ SE OS a 23. DRUMS Per, oration) > . Vet (Perf ) ; —ee fry _ (Visual acuity and refraction ; : . 24. EYES—GENERAL Vy oe “86 aed on) - -- 25. OPHTHALMOSCOPIC re -- ~ 26, PUPILS (Equality and reaction) REG 143 {7 — +—__} (Associated parallel move- Jad. OCULAR MOTILITY ments, nystagmus) ~~" 28. LUNGS AND CHEST (Include breasts) 39. HEART (Thrust, size, rhythm, sounds) i BO-VASCULAR SYSTEM (Varicosities, etc.) \_[-3T. ABDOMEN AND VISCERA (Include hernia) , (Hemorrhoids, Aatular) 32. ANUS-AND RECTUM (prostate, if indicated) . ENDOCRINE SYSTEM “Strength, range of motion) We. FEET ; (Except feet) +97. Lower EXTREMITIES (f7cePs f rarige of motion) ; oe — 38-SPINE, OTHER MUSCULOSKELETAL 39. IDENTIFYING BODY MARKS. SCARS, TATTOOS 4 0. SKIN, LYMPHATICS PE ine . NEUROLOGIC (Uquilibrium tests under item 72) Pols . : Ay f Ads PSYCHIATRIC (Specify any personality deviation) ; . - : ; : eS 9 43. PELVIC (Females only) (Check how done) <] iad Oo VAGINAL [_] RECTAL 0 - / x an cr ors (x = od sone . Non... sos : Replaced . Figed 1 2. 3) Restorable 1 2 1 2.3) Missing 1 2. 3 12. 3 . 373130 ret L 1 30” ‘cet 3731 30 teeth 37 3T 0 deenres % 31 ) ni 0 ~~ x , xx ox R \ 1 12 13 an B. ALBUMIN C. SUGAR oO LAST SIX MONTHS i Enter pertinent item number before each Continue in item 73 and use additional sheets if necessary.) ~ tf" petted ~ ZA » ’ ADDITIONAL DENTAL DISEASES 49. BLOOD TYPE AND RH FACTOR 50, OTHER TESTS Docld: 322784555 Page 2?
Released under the John F. Kennedy Assassination Records Correction BI vk us usc 2107 Hote). 55. BUILD: O SLENDER a MEDIUM id Heavy [_] OBESE 51. HEIGHT 56. TEMPERATURE 57. = BLOOD PRESSURE ey, at heart 5% A c. siTTiNg * =] RECUM-” STANDING BENT _| DIAS. eles A = min.) f 59. : DISTANT VISION: - . REFRACTION “ 6. * NEAR VISION RIGHT 20/ 3 OQ CORR, TO 20/ 2a ; ST we o ex) ™ A ‘Ze fCORR.TO JP BY 7 2 cco LEFT 20/ @_* CORR TOM fp BY oe s. ox eg N41, >> 62. HETEROPHORIA (Specify distance) | —s° EX? R. H. . LH PRISM Div. . . PRISM CONV. PC PD 63. ACCOMMODATION | 64. COLOR VISION (Test used and res 65. DEPTH PERCEPTION UNCORRECTED 7) (Test used and score) LEFT . at CORRECTED ro 67. NIGHT VISION (Test used and score) 69. INTRAOCULAR TENSION 66. FIELD OF VISION ‘| 68. RED LENS TEST 70. oe HEARING 72, PSYCHOLOGICAL AND PSYCHOMOTOR AUDIOMETER (Tests used-and score) LEFT wv assy jas ‘[ RIGHT tetetors 5 Sol — | fir Sts Ts asl oles = on + . ’ ; . Jr ¥ as : ; 4 an (Use additional sheets if necessary) / 74, SUMMARY OF DEFECTS AND DIAGNOSES (List aon item numbers) ° a f Aut LA, _ ltend- ote. ; 75. RECOMMENDATIONS—FURTHER SPECIALIST EXAMINATIONS INDICATED (Specify) a A. PHYSICAL PROFILE vn a «TI; EXAMINEE (Check). j A. O 1S QUALIFIED.FOR B. PHYSICAL CATEGORY By NOT QUALIFIED FOR ‘ - . : 78. IF NOT QUALIFIED. LIST DISQUALIFYING DEFECTS BY ITEM NUMBER } «a | 8 [| c¢ | E 79. TYPEQ OR PRINTED NAME OF PHYSICIANZ ; IS Za ” . A Mei pars 2 LES DS aw 80. TYPED OR PRINTED NAME OF ay SIGNATURE ‘ > ,81, TYPED OR PRINTED NAME OF DENTIST OR PHYSICIAN (( Indicate which) “ SIGNATURE } 82. TYPED OR PRINTED NAME OF REVIEWING OFFICER OR APPROVING AUTHORITY SIGNATURE - NUMBER OF AT- ' a TACHED SHEETS _ . oF Bs b an . a . . . w U.S. GOVERNMENT PRINTING OFFICE : 1969 O0-—-352-273 (49J) a . a Faint . ot : rs : Py : ad < i 3 * : ‘ a “ } e i x _.¢ & rs te a — Docld: 322784555 Page 3 ‘