‘Released under the John F. Kennedy Assassination Records Collection Act of 1992 (44 USC 2107 Hote). | DATE: 11-14-2017 JFK Assassination System Identification Form Agency Information AGENCY: FBI RECORD NUMBER: — 124-10134-10454 RECORD SERIES: HQ AGENCY FILENUMBER:  67-494012-187 Document Information ORIGINATOR: FBI FROM: KC TO: TITLE: DATE: 06/23/1972 PAGES: 5 SUBJECTS : JAMES P. HOSTY JR. DOCUMENT TYPE: PAPER, TEXTUAL DOCUMENT CLASSIFICATION: — Unclassified RESTRICTIONS: 3 CURRENT STATUS: —Redact DATE OF LAST REVIEW: 08/26/1998 OPENING CRITERIA: INDEFINITE COMMENTS : MED RPT, INC FD-300 v9.1 Docld: 3227865175 Page 1 23
€ AReL eased undér the John F. Kennedy Assassination Records Collection Act of 1992 (44 US€.2 DATE: 11-145 . PN, oe . DATE tar La be 2017 a : YX ; + Revised April 1968 ~ 7 ) hee . 7 : -General Ser vites Administration | a fe aan fe ” Interagency:Comm. on Medical Records ; “ . CAL EXAMINAT Ne Interagency: Comm: \. “REPORT OF MEDICAL EXAMINATIO a SINLAST NAME-—FIRST NAME—MIDDLE NAME : oS . 2. GRADE AND COMPONENT OR POSITION ~ 3. IDENTIFICATION NO, . ‘ at HOSTY, JAMES PATRICK JR Civilian SA | 354 16 1823 4#HOME ADDRESS (Number, street or RFD, city or town, State and ZIP Code) 5. PURPOSE OF EXAMINATION ; 6. DATE OF EXAMINATION 3014 W. Sst Terr Shawmee Mission, Kansas 66205 Annual — 23 Jun 72 : . ; 2. SEX - “18, RACE © 9. TOTAL YEARS GOVERNMENT SERVICE . 10, AGENCY VW. ORGANIZATION UNIT - - Male. Caucasian — [muitary = 3 FBI Ne 46) aid ~ . “12. DATE OF BIRTH — 13. PLACE OF BIRTH . ; 14. NAME, RELATIONSHIP, AND ADDRESS OF “NEXT OF KIN . Co... (47) Oe | Janet P. Hosty(Wife) 28 ‘Aug 2h Chicago, Illinois Same as Item #4 | mie EXAMINING FACILITY OR EXAMINER, AND ADDRESS a 16; OTHER INFORMATION - a USAF Hospital (AFCS) Richards-Gebaur AFB, Mo. le > 17. RATING OR SPECIALTY . . . TIME IN THIS CAPACITY (Total) - "LAST SIX-MONTHS CLINICAL” EVALUATION: {Check each item-in appropriate col. NOTES: (Describe every abnormality in detail. Enter pertinent item number before each comment. Continue in item 73 and use additional sheets if necessary.) >]. D Zz ° a ot evaluated. = x m > > > = Ss a OL - c “0 i~J 3 js a a 2 8 2 : by se = . 1 ‘ a a FLELEL LLL LL , ro 5 _~ SF Q RN Ct Ww “—n > oO m 2 m Qa a 19, NOSE. : rm | rile zie o|}2 S|-& ‘x= | m Zia > = o a =x a oO > A Tonsils enuc leated. p cd . - Cnt, & ext. canals) (Audit 22, EARS—GENERAL acuity under inals) 70 and 71) 23, DRUMS (Perforation) (Visual acuity and refraction under items 59, 60 and.67) 25, OPHTHALMOSCOPIC 26. PUPILS (Equality and reaction) 27. OCULAR MOTILITY (Associated parmtiel move 28, LUNGS AND CHEST (Include breasts) — 29. HEART (Thrust, size, rhythm, sounds) , 30,. VASCULAR SYSTEM (Varicosities, etc. ) 31, ABDOMEN AND VISCERA (Include hernia) 32, ANUS AND RECTUM (Hemorrhoids, fistuléc) 33, ENDOCRINE SYSTEM Py S m ~< m on Qo m z m Dz > Fa Po PS Ta [Pd fee | [bd Jed TS PS [Pd | 2s ethea wo Numbered ne Fad 2 fom n” 4 a 4 m. = Circumcision, WHNS. 3¢__|35. UPPER EXTREMITIES (Stengyh. range of . : 36. FEET 37, LOWER EXTREMITIES (Ex eeP! °° 26 of motion) 38, SPINE, OTHER MUSCULOSKELETAL -]39, IDENTIFYING BODY MARKS, SCARS, TATTOOS x 40, SKIN, LYMPHATICS - 4], NEUROLOGIC (Equitibrium tests under item 72) ia - RED-LEgy Birthmark 1" left scapitat area, NS.- Scar 2' left temple, WHNS. oo ne w ° 42, PSYCHIATRIC (Specify any personality deviation, 43, PELVIC (Females only) (Check how done) : LJ vacinat. ["] RECTAL ; : (Continue in item 73) an ye 44. DENTAL (Place appropriate symbols, shown in examples, above or below number of upper and lower teeth.) |) REMARKS AND ADDITIONAL DENTAL : . DEFECTS AND DISEASES yj. ee ee Restorahle ave _2_5 2 3 restorable Lie 2_3 Missing J2 3 Replaced ETRE 3 Panial . ; + st teeti a teeti . : 4 %. 2 oe ae Cee Z 31 30 te BAT W detilres 31 Hdenure | Exam type 3 ee ee ee ee SS | |) Class 1 32 31 30 23 28 27 6 re) 24 23 22 a 28 19 18 uv ‘|42a-2 an . 7 LABORATORY FINDINGS ~ 45, URINALYSIS: A, SPECIFIC‘GRAVITY e , 46, CHEST X-RAY’ (Place, date, film number and result) ER eget ticharletfelade S88, wel ™™33 sun 1 P| _6. SUGAR a Negative Richards-Gebaur AFR, Mo. _23_Jun {2 - 47, SEROLOGY (: pecify test used and result) z 48, EKG. 49. BLOOD TYPE AND RH — 50, OTHER TESTS ; we FACTOR ; | ‘| RER ~ Negative ‘Normal | "0" Pos B/R Het 47% © as $8.117-02 \ 7 EMG A r2 8 —_ wera — a ce fe '}Docld: 32265178 Page 2 ‘