Agency: FBI
Originator: FBI
From: KC
Document date: 05/22/1970
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 :

124-10134-10436

RECORD SERIES:

HQ

AGENCY FILE NUMBER : 67-494012-178

Document Information

ORIGINATOR: FBI

FROM: KC

TO:

TITLE :

DATE :

PAGES:

SUBJECTS :

05/22/1970

4

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: 32285160

19

Page 1

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Released under the John F. Kennedy Assassination Records

Cottection Act of 1992 (44 USC 2107 Note).

•DATE: 11-11-2017

Star:

Re•

Aprils1968

Gerr

Services Administration

Interagency Coinm. on Medical Records

FPM R. 101-11.809-3

i. LAST NAME-FIRST NAME-MIDDLE NAME

HOSTY, James Patrick, JI.

4. HOME ADDRESS (Number, street or RFD, city or town, Slate and ZIP Code)

3014 W. 51st Terr.

Shawnee Mission, Kansas

66205

7. SEX

8. RACE

9. TOTAL YEARS GOVERNMENT SERVICE

Male

Caucasian

MILITARY

3

CIVILIAN

12. DATE OF BIRTH

13. PLACE OF BIRTH

(45)

28 Aug 1924

Chicago, Illinois

15. EXAMINING FACILITY OR EXAMINER, AND ADDRESS

4676 USAF Hospital, R-G AFB, Mo.

17. RATING OR SPECIALTY

REPORT OF MEDICAL EXAMINATION

2. GRADE AND COMPONENT. OR POSITION

Civilian

5. PURPOSE OF EXAMINATION,

3.-IDENTIFICATION NO:

354-16-1823

6. DATE OF EXAMINATION

18

Annaul FBI

22 May 1970

10. AGENCY

11. ORGANIZATION UNIT

FBI

Kansas City,

Missouri

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

Janet P. Hosty (wife)

(same as #4)

16. OTHER INFORMATION

TIME IN THIS CAPACITY (Total)

LAST SIX MONTHS

CLINICAL EVALVATION

NOR

MAL

X

X

X

he each em in appearialed

want trende

NOTES: (Describe every

conormality in detai

ABNOR-

MAL

18. HEAD, FACE, NECK, AND SCALP

19. NOSE

20. SINUSES

21. MOUTH AND THROAT

Int. & ext. canals) (Auditor

X

22.

EARS-GENERAL

scuity under items 70 and 71

#21. Whitish confluent buccal erruption.

character. Tonsils enucleated.

Papular in

23.

DRUMS (Perforation)

24. EYES-GENERAL under items

(Visual acuity and refraction

59, 60 and 67

25.

OPHTHALMOSCOPIC

X

26.

PUPILS (Equality and reaction)

27. OCULAR MOTILITY (Associated parallel move-

ments, nystagmus)

X

28. LUNGS AND CHEST (Include breasts)

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

30.

VASCULAR SYSTEM (Varicosities, etc.)

31.

ABDOMEN AND. VISCERA (Include hernia)

Hemorrhoids, fistulae

32.

ANUS AND RECTUM (Prostate, if indicated)

33. ENDOCRINE SYSTEM

34. G-U SYSTEM

#34. Circumcised.

35. UPPER EXTREMITIES

(Strength, range of

motion)

36: FEET

REC-142

64-4940/2 - 178

Searched

Natibered

JUL 14 1970

137. LOWER EXTREMITIES' Except feet)

(Strength, range of motion)

38. SPINE, OTHER MUSCULOSKELETAL

39. IDENTIFYING BODY MARKS, SCARS, TATTOOS

40. SKIN, LYMPHATICS

X 41. NEUROLOGIC (Equilibrium tests under item 72)

#39. Birthmark 1/2" long left scapula.

scar on right thigh, WHNS.

42. PSYCHIATRIC(Specify any personality deviation)

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

XEROX

MAR

10 1980

VAGINAL

[7 RECTAL

44. DENTAL (Place appropriate symbols, shown in examples,

ENCLOSURI

aböve or below number of upper and lower teeth.)

(Continue in ilem 73)

EMARKS AND ADDITIONAL DENTA

EFECTS AND DISEASI

Restorable

31

30

teeth

3

Non-

restorable

32

31

30

teeth

32

*N

31

3

Missing

30

teeth

32

31

3 Replaced

30

by

denture

32

Fixed

Partial

31 30 dentures

Exam Type 3

Class 2

LABORATORY. FINDINGS

45. URINALYSIS:

A. SPECIFIC GRAVITY

B. ALBUMIN

Negative

Negative

47. SEROLOGY (Specify test used and result)

RPR - Negative

1.012

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

D. MICROSCOPIC

14 X 17 Film No. 70-4536

Negative

Richards-Gebaur AFB, Mo.

49. BLOOD TYPE AND RH

50. OTHER TESTS.

'orAcositive

Normal

(by record)

HCT: 46 Vols%

22 May 1970

Normal

_88:11791

DocId: 32285160

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Released under the John F. Kennedy Assassination Records Collection Act of 1992 (44 USC 2107 Hote) .

bATE. 11-14-2017

MEASUREMENTS AND OTHER FINDINGS

51. HEIGHT

52. WEIGHT

53. COLOR HAIR

54, COLOR EYES

55. BUILD.

56. TEMPERATURE

73

190

Brown

Brown

• SLENDER

X MEDIUM

HEAVY

OBESE

57.

BLOOD PRESSURE (Arm at heart level)

58.

PULSE (Arm at heart level)

A.

sYs. 110

B.

SITTING

DIAS.

84

RECUM-

SYS.

C.

SYS.

A. SITTING

B. AFTER EXERCISE

C. 2 MIN. AFTER

D. RECUMBENT

E. AFTER STANDING

STANDING

3 MIN.

BENT

DIAS..

-

(3 min.)

DIAS. -

66

90

66

59.

DISTANT VISION

60.

REFRACTION

61.

NEAR VISION

•RIGHT 20/ 20

CORR. TO 20/

BY

20/20

CORR. TO

BY

LEFT 20/

20

CORR. TO 20/

BY

-

CX

20/20

CORR. TO

BY

62. HETEROPHORIA (Specify distance)

ESO

EX°

R. H.

L. H.

*PRISM DIV.

63.

RIGHT

ACCOMMODATION

LEFT

66. FIELD OF VISION

Normal

HEARING

64. COLOR VISION (Test used and result)

Passes

VTS-CV

67. NIGHT VISION (Test used and score)

NIBH

ORTHO

65. DEPTH PERCEPTION

(Test used and score)

68. RED LENS TEST

70.

RIGHT WV

PC

PD

UNCORRECTED

CORRECTED

69. INTRAOCULAR TENSION

OU.

17.3

T2. PSYCHOLOGICAL AND PSYCHOMOTOR

(Tests used and score)

/ 15 SV

-

/ 15

71. BELTONE

250

LEFT WV

/ 15 SV

/ 15

RIGHT

LEFT-

73. NOTES (Continued) AND SIGNIFICANT OR INTERVAL HISTORY

AUDIOMETER

ISO

502

Lurent

1024

2000

2896

4090.

6000

30

20

0 01 30/55

1\50| 601

3000

-

Tonsillectomy in childhood, no comp, no seg.

Circumcised in infancy, no comp, no seg.

Scar on right thigh, cut on barbed wire

at age 8, no comp, no seg.

Mother had cancer, no signs or symptoms in examinee.

Father has rheumatism, no signs or symptoms

in examinee.

Sister has asthma, no

signs or symptoms in examinee.

Examinee denies all other significant medical/surgical history.

(Use additional sheets if necessary)

74. SUMMARY OF DEFECTS AND DIAGNOSES (List diagnoses with item numbers)

Dental evaluation

I buccal erruption.

75. RECOMMENDATIONS- FURTHER SPECIALIST EXAMINATIONS INDICATED (Specify)

77. EXAMINEE (Check)

A. [IS QUALIFIED FOR

B. DJ IS NOT QUALIFIED FOR

78. IF NOT QUALIFIED, LIST DISQUALIFYING DEFECTS BY ITEM NUMBER

79. TYPED OR PRINTED NAME OF PHYSICIAN

BYRON R. JOHNSON, Capt, USAF MC

80. TYPED OR PRINTED NAME OF PHYSICIAN

81: TYPED OR PRINTED NAME OF DENTIST OR PHYSICIAN (Indicate which)

82. TYPED OR PRINTED NAME OF REVIEWING OFFICER OR APPROVING AUTHORITY

76.

A. PHYSICAL PROFILE

B. PHYSICAL CATEGORY

SIGNATURE

NUMBER OF AT.

TACHED SHEETS

#U.S. GOVERNMENT PRINTING OFFICE: 1969 - 330-241

DocId: 32285160 Page 3

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