'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: — 124-10132-10096 RECORD SERIES: HQ AGENCY FILE NUMBER: 67-494012-206 Document Information ORIGINATOR: FBI FROM: KC TO: TITLE: DATE: 09/03/1976 PAGES: 12 SUBJECTS : JAMES P. HOSTY JR. DOCUMENT TYPE: PAPER, TEXTUAL DOCUMENT CLASSIFICATION: — Unclassified RESTRICTIONS: 3 CURRENT STATUS: — Redact DATE OF LASTREVIEW: 09/01/1998 OPENING CRITERIA: INDEFINITE COMMENTS : MED RPT, INC FD-300 v9.1 1 Docld: 322784515 Page 1
af a . Kenned Bsaesination Records Collection Act of 1997 (44 USC 2107 Hote}. . a i , MWethddrd Porm s8 O17 Ay ‘ Revised, 2 rik 368 ey a . 0. \ General Bervices Administration * . = ~ Tnteragency Comms on Medical Records REPORT OF : MEDICAL EXAMINATION FPMR®*1 01-1 1.809-3 Sy ee a * ae : : a 3. IDENTIFICATION NO. 1. st, NAME—FIRST nA NAME 2. GRADE AND COMPONENT OR POSITION 5. PURPOSE OF EXAMINATION © 6. DATE OF EXAMINATION 4, HOME ADDR —_ ade street rape cityor town, Slate and ZIP Code) I Bork iaiaiemee fa @ 6 OT- Doel 3, bx 7, SEX, 7 al te 9. TOTAL YEARS GOVERNMENT SERVICE 10. AGENCY 11. ORGANIZATION UNIT yw] — ‘ ~ CIVILIAN. 12.,DATE OF BIRTH .. 13. PLACE OF BIRTH CDicage D0 diney & as anaar/s 16, OTHER INFORMATION , —— ; oe cA. IG op tl OR EXAMINER, AND ADDRESS . \ Her KC Ma. Ce Vv, rRATING OR S CIALTY 7 TIME IN THiS CAPACITY (Total LAST SIX MONTHS | CLINICAL EVALUATION ~ NOTES. (Describe every abnormality in detail. ‘Enter pertinent item number before’ each — H comment. Continue in item 73 and use additional sheets if necessary. an scones AME, OP fe P, By A SDRESS OF NEXT OF KIN ek ' { 4 NOR-- eck each item in appropriate col- . MAL*| umn, enter ‘'NE’’ it not evaluated. MAL” . pet 18. HEAD, FACE, NECK. AND SCALP oO ~ “ mT ~ 19. NOSE “T 20. SINUSES , } 21, MOUTH AND THROAT Hi _ (int. & ert. Tanale) (Auditory 22. EARS— GENERAL acutly under items 70 and 7!) 23. DRUMS (Perforation) i _ (Visual acuity and refraction | 24. EYES GENERAL under items 59, 60 and 67) 25. OPHTHALMOSCOPIC bot, - 7 . 26, PUPILS (Equality and reaction) | ——+ (Associated parallel move- 27. OCULAR MOTILITY je nts. nystagmus) 28. LUNGS AND CHEST (Include breasts) nny 29. HEART (Thrust, size, rhythm, sounds) ‘ 30. VASCULAR SYSTEM ( Varicosities, etc.) A TT 4 [3t. ABDOMEN AND VISCERA (Include hernia) ——— (Hemorrhoids, fistulae) 32. ANUS AND RECTUM (prostate, if indicated) 33. ENDOCRINE SYSTEM 5 is i re range a + Correia Luplet hake a7) abifvig | oe Ye Cite OT ed 37. LOWER EXTREMITIES (reer) fecd Strength. range of motion) i |. SPINE, OTHER MUSCULOSKELETAL - | : ~ . ae SIF ° 39. IDENTIFYING BODY MARKS, SCARS, TATTOOS , . te FIFO [x ‘a IG 20) 40. SKIN. LYMPHATICS ‘ _— a , REC- I Numh 4. Numbered \ +— — ; rs wee searohed umbere AY. NEUROLOGIC (Equilibrium teste under item 72) ii 7 a om ey 7 id. SEP aol 1976 ff 7 42. PSYCHIATRIC (Specifyany personality deviation) | a a 43, PELVIC (Femalés oily) (Check how done) ; eres ~ Se aadead Civacinat (Jrectat 1.2 3) Restoruble 1-23 Non 123 23 Missing. i 2 3 Repiced i 2 3 pane, 32 31 30 teeth 32 30 32 31 30 teeth 32-31 30 ar 323130 ern 0 . “tp teet x x x x lentures ( x ) lentures RX x Xx —_——— rama, s L b_} 2 3 4 5 6 7 8 9 a 6 CS SC a | ne ar nr) i; ee rd i) en <> i | | _ _ LABORATORY FINDINGS . é _\ / 4S. URINALYSIS: A. SPECIFIC GRAVITY B. ALBUMIN D. MICROSCOPIC . C. SUGAR. =: ,, a . 47. SEROLOGY iy SER" a rif ie ; ; a ., me 4. t : . 88-116 yp 49. BLOOD TYPE AND RH _ FACTOR AB, EKG 50, OTHERTESTS , 3.) , - ' Docld: 322764516 Page 2? ‘