‘Released under the John F. Kennedy Assassination Records Collection Act of 1992 (44 USC 2107 Hote). DATE: 11-14-2017 JFK Assassination System Date: 5/27/20] Identification Form Agency Information AGENCY: FBI RECORD NUMBER: = 124-10134-10486 RECORD SERIES: HQ AGENCY FILENUMBER: 67-494012-202 Document Information ~ ORIGINATOR: FBI FROM: KC TO: TITLE : DATE: 08/01/1975 PAGES: 4 SUBJECTS : JAMES P. HOSTY JR. DOCUMENT TYPE: PAPER, TEXTUAL DOCUMENT CLASSIFICATION: — Unclassified RESTRICTIONS: 3 CURRENT STATUS: — Redact DATE OF LASTREVIEW: 08/31/1998 OPENING CRITERIA: INDEFINITE COMMENTS : MED RPT, INC FD-300 v9.1 26 | Docld:32265210 Page 1 ‘
= Dw Is ed tlor 4882017 ; a févised April 1968 General Services Administration Interagency Comm. on Medical Records FPMBY 101-11.809-3 WF LAST) NAME FIRST NAME—MIDDLE NAME ee . . ‘ . lesty. SAues PatRict,,, Tk 1... 6-6 9 2S~Ib-1R3: (“ Hof ADDRESS (Number, rato BED, city or town, Stateand ZIP Code) = aaa “| 6. DATE OF EXAMINATION ' j . 7 An = ane la PET A Dhiirvrnte Mntadion 2 C6E6DOL ‘ ; ; 7, SEX 10. AGENCY’ 3 11. ORGANIZATION UNIT 12. DATE OF BIRTH - | 13. PLA! nN 14. NAME, RELATIONSHIP, AND Al ESS OF NEXT OF KIN aS AVE MH4\ ‘ vt? AME . (POSTY C* - ? Released under the John F. Kennedy Assassination Records Collection Act of 1992 (44 USC 2107 Hote}. ay ate aa + ‘ , 15. EXAMINING FACILIT OR EXAMINER, "te = mo = oe re ~ 116. OTHER INFORMATION 7 USAF frcharhe Acta AFR Pro Cus) 34-16-1873 nae » TIME IN THIS CAPACITY (Total) LAST SIX MONTHS ‘ Enuclete) 9 9 | 17, RATING OR SPECIALTY 4 , om a t { CLINICAL EVALUATION NOTES. (Describe every abnormality in detail’ Enter pertinent item number before each TOR sok each itemin appropriate col. TABNOR- comment. Continue in item 73 and use additional sheets if necessary.) i. “MA *umn: enter'‘NE’’ it not evaluated: «ea ne : an t 18. HEAD. FACE. NECK. AND SCALP ee 3. T3 ae Is 21. MOUTH AND taRoaT Lon ‘ wal Bet Cel Cnt. & ert. canals) (Auditory | ge? 22. EARS\—GENERAL (icity under stems 70 and 71) | 23. DRUMS (Perforation) a (Visual acuity and refraction 24. EYES—GENERAL under items 59, 60 and 67) 25. OPHTHALMOSCOPIC 26. PUPILS (Equality and reaction) (Aasociated parallel move 27. OCULAR MOTILITY ments, nystagmus) 28. LUNGS AND CHEST (Jnclude breasts) i a 29. HEART (Thrust, size, rhythm, sounds) |_| 30. VASCULAR SYSTEM ( Waricosities, etc.) 31. ABDOMEN AND VISCERA (Include hernia) (Hemorrhoids, fistulae) 32. ANUS AND RECTUM (Prostate, if indicated) 33. ENDOCRINE SYSTEM 34. G-U SYSTEM yo ~ Oa 35. UPPER EXTREMITIES ‘Sérenoth, range of v motion) 4 7 ; yo, EW ("Searched Lo ored } /ENCLosy REC 145 _& US _28 197 xs en e. 36, FEET (Except feet) . | 37. LOWER EXTREMITIES (Strength, range of motion) *| "38. SPINE, OTHER MUSCULOSKELETAL ~ te: 39. IDENTIFYING BODY MARKS. SCARS, TATTOOS | 40. SKIN, LYMPHATICS 41. NEUROLOGIC (Equilibrium teate under item 72) 42. PSYCHIATRIC (Specify any personality deviation) 43. PELVIC (Females only) (Check how done) (Cvacinat Drectat-|.-. - Do, 44. DENTAL (Place appropriate symbols, shown in examples, above or below number of upper and lower teeth.) REMARKS AND ADDITIONAL DENTAL .- DEFECTS AND DISEASES ~ : ‘ 0 oo / vest k mote KT OX Gx Dog : Non- “1° ape - Replaced 7 Fixed “ . . - D2 2. Restorable 1.203 12 3 Missing lL. 7 wernace .l : ‘i 2 ow. ffee. - _ RN 30 teeth 3% 31 30 restorable 3231 30 teeth 30 by 32 31~=«430 ke artial ——_ 0 - i etn. x - x x Y fentures { x ) entures ; . - 1 1 2 3 4 § 6 7 8 9 10 1 12 13 14 15 16 &£ qos - ' if A @ ual Lf cel , 7 ; “"—AABORATORY FINDINGS, . —_ ! 45. URINALYSIS: A. SPECIFICGRAVITY 1,020: ~ ‘ a, X-RAY (Place, date, film number and result) } B. ALBUMIN g mo , , . . woo ‘ | c. SUGAR at oe A ah. WO, jf 7S - CE 7S 5 ae n= = - < zt . . : H 47, SEROLOGY (Specify test jsed and result) + 50, OTHER TESTS. “oe ; we ! ] SEP 5 19 mal . : a Se - ret ad |; Docld: 3227852710 Page 2? ‘
[Released os the Mohn F. Kennedy Assassination Records Collection Le aa vp. a 2107 Hote). a a eee MEASUREMENTS AND OTHER FINDINGS: _ |'S6. TEMPERATURE 51. ae $2. 04, 54. COLOR EYES” “| 55. BUILD: © ‘ mens AYN B O SLENDER Oo mepium [XJ HEAVY qo ovese|  ~——-— 57. _ BLOOD oe (Arm, at heart level) Spt bo tape ac, PULSE (Arm at heart level)” ra Ai |B. 5 evs. 7 a siting. |. “AFTER EXERCISE |C. 2 MIN. AFTER |” ‘SITTING RECUM-. scahoine ve | “en eZ aie) pas. / a | 9 vistaNT VISION, ° REFRACTION / fy Base es IO - +, gNEAR VISION RIGHT 20/ “Jy CORR. TO 20/ Fatt CORR. To _ BY tare LEFT 20; ” +. CORR, To 207°" {1s CORR.TO 4% BY 62. HETEROPHORIA (Specify distance) cee ee ee —- P| an ES° EX? R.H. (oo, PRISM DIV. ~-prismconvs ff an PD 63. ACCOMMODATION m4 UNCORRECTED rad i ee — 66. FIELD OF VISION (69. INTRAOCULAR TENSION — a! J it, AS To A _ < 7, + HEARING nat ate AUDIOMETER A if CP P/ GAG | 72. PSYCHOLOGICAL AND PSYCHOMOTOR (Tests s used and score) son = Lieteieisise ae =_— 73. NOTES (Continued) ‘AND SIGNIFICANT OR! INTERVAL’ HISTORY H ee aime 12 Sa t ~ a ” : . E . Le, wo ‘ Loe . \ - Xx A x f Nl Ff E . . . 44 i . y" f E . ’ - Som CF Ofap DEV es Famicy \ ' es cou a) ETES SES yeu. ie H xX — YSIS ugeE AE haat: vy O te. - Cobehee : a (SC. / Li 2Giceal Mey hos é< Te, lass A LL SEVERE woe, . . . . sma: * “ht a . , 78.  RECOMMENDATIONS-—FURTHER SPECIALIST EXAMINATIONS: INDICATED (Specify) A. PHYSICAL PROFILE on a + ! 77, EXAMINEE (Check), Moe peer tq gee ef /s J [ler al -1A4l fee cee EEE a. Ud'ts quauirieo For. .C. © wee Ne ah oa \ J? B. PHYSICAL CATEGORY eo rhoett \ +- : 8. G IS NOT ‘QUALIFIED F FOR ; fi) af oo * ee ce 77. A A Aw. . 78. IF NOT QUALIFIED, LIST DISQUALIFYING DEFECTS BY rTM NUMBER 7 ew OP ee 79. TYPED OR PRINTED NAME OF F SICIAN av wi MER y, 4 ~ y u = Mm ed . IF -. 2 S- . cote ee DP uCGfhe T.~ StfaHlé: LAL, I 52 EAC AK : 80 TYPED'OR PRINTEO NAME OF PHYSICIAN a ne Fy ue } ; a fom or ms, - ‘oe A tee em } 81. TYPED OR PRINTED NAME oF DENTIST OR PHYSICIAA (Indicate which) SIGNATURE , : ‘ : _ : ~ 1s > . . . om a ae a . | “# ” ' 62. TYPED OR PRINTED NAME OF REVIEWING (OFFICER OR APPROVING AUTHORITY = —_ NUMBER OF AT- Lo , TACHED SHEETS + a re i a a ; ; — - Lan , . . — a vy GPO: 1971 446-044/15 : we oo. t, I" “a fy. : Lj baa i : oo. i ' Docld: 322652710 Page 3 ‘