Agency: FBI
Originator: FBI
From: KC
Document date: 06/23/1972
Document type: PAPER, TEXTUAL DOCUMENT

## Page 1

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 :

124-10134-10454

RECORD SERIES:

HQ

AGENCY FILE NUMBER:

67-494012-187

Document Information

ORIGINATOR: FBI

FROM:

TO:

KC

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

DocId: 32285178

23

Page 1

---

## Page 2

Released under the John F. Kennedy Assassination Records Collection Act of 1992 (11 USC 2107 tote).

DATE

Srandard form 86.201

Revised April 1968

General Services Administration

Interagency: Commi on Medical Records

EPMR 101-11.809-3

MI. LAST NAME-FIRST NAME - MIDDLE NAME

HOSTY, JAMES PATRICK JR

4.#HOME ADDRESS (Number, street or RFD, city or lown, State and ZIP Code)

3014 W. 51st Terr

Shawnee Mission, Kansas

7. SEX

8.. RACE

Male

Caucasian

66205

9. TOTAL YEARS GOVERNMENT SERVICE

MILITARY

3

CIVILIAN

20

12. DATE OF BIRTH

13. PLACE OF BIRTH

(47)

28 Aug 24

Chicago,

Illinois

15. EXAMINING FACILITY OR EXAMINER, AND ADDRESS

USAF Hospital (AFCS) Richards-Gebaur AFB, MO.

7, RATING OR SPECIALTY

REPORT OF MEDICAL EXAMINATION

2. GRADE AND COMPONENT OR POSITION

Civilian

5. PURPOSE OF EXAMINATION

SA

3. IDENTIFICATION NO.

354 16 1823

6. DATE OF EXAMINATION

Annual

10. AGENCY

11. ORGANIZATION UNIT

FBI

C0.89=

14. NAME, RELATIONSHIP, AND ADDRESS OF NEXT OF KIN

Janet P. Hosty Wife)

Same

as Item f4

16: OTHER INFORMATION

23 Jun 72

cite

TIME IN THIS CAPACITY (Total)

LAST SIX-MONTHS

CLINICAL EVALUATION

NOR-

MA

Check each in not roariate do

NOTES: (Describe every

ABNOR-

comment.

abnormality in detail.

Enter pertinent item

number before each

Continue in item 73 and use additional sheets if necessary.)

18. HEAD, FACE, NECK, AND SCALP

19. NOSE.

20, SINUSES

21. MOUTH AND THROAT

21. Tonsils enucleated.

22. EARS-GENERAL

acuity under items

cuts end enems to and y

23. DRUMS (Perforation)

4. EYES-GENERAL (Visual acuity and refraction

nder items 59, 60 and 67

25. OPHTHALMOSCOPIC

26. PUPILS (Equality and reaction)

27. OCULAR MOTILITY (Associated parallel move-

ments, nystagmus)

28. LUNGS AND CHEST (Include breasts)

29. HEART (Thrust, size, rhythm, sounds)

30, VASCULAR SYSTEM (Varicosities, etc.)

Bulet to sAc

Rei

ea-protection

sins

7-24-72

X.

31. ABDOMEN AND VISCERA (Include hernia)

32. ANUS AND RECTUM

(Hemorrhoids, fistulae)

(Prostate, if indicated)

33: ENDOCRINE SYSTEM

34. G-U SYSTEM

x

34.

ENCLOSURE

Ci

rcumcision, WHNS.

67.4.0

'Isinher

35. UPPER EXTREMITIES (Strength, range of

motion)

36. FEET

2-18

Numbered

5 JUL 19 1972 39

37. LOWER EXTREMITIES (Strength, range of motion)

REC-134

38. SPINE, OTHER MUSCULOSKELETAL

39. IDENTIFYING BODY MARKS, SCARS, TATTOOS

X

39.

40. SKIN, LYMPHATICS

Sms

Birthmark I" left scapular area, NS.

scar 2' left

temple, WHNS.

41. NEUROLOGIC (Equilibrium tests under item 72)

42, PSYCHIATRIC(Specify any personality deviation)

43, PELVIC (Females only) (Check how done)

I VAGINAL [J RECTAL

44, DENTAL (Place appropriale symbols, shown in examples, above or below number of upper and lower teeth.)

Restorable

3

Non-

restorable

§ Replaced

32

• 30

leeth X

X32

31 30

leeth

3 Missing

32

31 30

open.

32 31

30

x

dentures

(Continue in item 73)

MAAR

REMARKS AND ADDITIONAL DENTAL

DEFECTS AND DISEASES

Fixed

Partial

31

30, dentures

Exam type 3

Class 1

LABORATORY FINDINGS

45. URINALYSIS: A. SPECIFIC GRAVITY

1,021

B. ALBUMIN

Negative

D, MICROSCOPIC

C. SUGAR

Herative

47. SEROLOGY (Speculy test used and result)

48. EKG

RPR - Negative

• Normal

46, CHEST X-RAY (Place, date, film number and result)

Negative

49 BLOOD TYPE AND RH

FACTOR

"O" Pos B/R

14 × 17 Film 72 6981

Normal

Richards-Gebaur AFB, MO.

23 Jun 72.

50. OTHER TESTS

Hct 47%

88-117-02

49

AUG 1

1972

DocId: 32285178

Page 2

---