Agency: FBI
Originator: FBI
From: KC
Document date: 4/10/67
Document type: PAPER, TEXTUAL DOCUMENT

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Released under the John F. Kennedy Assassination Records Collection Act of 1992 (41 USC 2107 Hote).

DATE: 11-14-2017

JFK Assassination System

Date:

5/27/201

Identification Form

Agency Information

AGENCY: FBI

RECORD NUMBER: 124-10134-10414

RECORD SERIES: HQ

AGENCY FILE NUMBER: 67-494012-167

Document Information

ORIGINATOR: FBI

FROM: KC

TO :

TITLE :

DATE:

04/10/1967

PAGES:

4

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: 32285138

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Released under the John F. Kennedy Assassination Records Collection Aot of 1992 (14 USC 2107 Hote) .

DATE:

standara Form 88 111

(Rev.

Stane 1956)

Bures of the Budget

CircHist A-32 (Rev.)n

LAST NAME- FIRST NAME- MIDDLE NAME

HOSTY, James Patrick, Jr:

4. HOME ADDRESS (Number, streel or RED, city or lown, zone and State)

3014 West 5lst Terrace

Shawnee Mission, Kansas

66205

7. SEX

8. RACE

9. TOTAL YEARS GOVERNMENT SÉRVICE.

Male

Caucasian

MILITARY,

3

CIVILIAN 15

12. DATE OF BIRTH.

13. PLACE OF BIRTH

REPORT OF MEDICAL EXAMINATION

2. GRADE AND COMPONENT. OR POSITION

Special Agent: FBI

5.: PURPOSE OF EXAMINATION

88-109-01

3. IDENTIFICATION NO.

7392

6. DATE OF EXAMINATION

FBI Annual:

10. AGENCY

11: ORGANIZATION UNIT

FBI

FBI (Kansas City)

14: NAME: RELATIONSHIP. AND ADDRESS'OF NEXT OF KIN

Janet P. Hosty (Wife)

Same as Item 74

16. OTHER INFORMATION

10 Apr 67

-28 Aug 24. (42)

Chicago, Illinois

15: EXAMINING FACILITY OR EXAMINER. AND ADDRESS

838. TAC HOSPITAL, FORBES AFB, KANSAS 66620

•17. RATING'OR SPECIALTY

TIME IN THIS CAPACITY (Total)

LAST SIX MONTHS

CLINICAL EVALUATION

NOTES.. (Describe every abnormality.in

comment.

detail

. Enter

pertinent stem

number bofore each

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

(Check each item in

appropriato

umn; enter

if not evaluated.)

ABNOR•

MAL

X.

x'

18. HEAD. FACE, NECK. AND SCALP

19. NOSE.

20. SINUSES.

21.

MOUTH AND THROAT

*

22. EARS-GENERAÍ (Int. & ext. canala) (Auditory

seuity under. items 70 and is

23.

DRUMS (Perforalion)

24. EYES-GENERAL Wieral emiss, od refractio

refraction

25. OPHTHALMOSCOPIC

26: PUPILS (Equality and reaction)

X

27.

OCULAR MOTILITY

(Associaled

parallel move-

ments, nystagmus)

28.

LUNGS AND CHEST (Include breasts)

29.

HEART (Thrust, size, rhythm, sounds)

30, VASCULAR SYSTEM (Varicosities, elc.)

X

31.

ABDOMEN AND VISCERA (Include hernia)

32. ANUS AND RECTUM (Hemorrhoids, fatulge)

(Prostate; if indicated)

32:

Prostate and rectum normal to digital examination

33. ENDOCRINE SYSTEM

34. G-U. SYSTEM

34. Atrophic right testicle.

35. UPPER EXTREMITIES

(Strenoth, range of

morton.

36.

FEET

37.

LOWER EXTREMITIES (Strenoth, rance of motion)

38. SPINE, OTHER: MUSCULOSKELETAL

39. IDENTIFYING BODY MARKS. SCARS: TATTOOS

40: SKIN, LYMPHATICS

41, NEUROLOGIC (Equilibrium feats under ilem ie)

42. PSYCHIATRIC (Specifu any personalitu deviation)

ENCLOSURE

REC-137

61-4/940/2= 16y

Searcher

B MAMA 567 387

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

VAGINAL D RECTAL

44., DENTAL. (Placé upprópriale sumbols above oribelow number of upper and lower teeth, respectivelsy.).

O- Restorable teeth

•X-Missing teeth

/-Nonrestorable teeth

XXX-Replaced by dentures

2'

3-

30

5

28-27

7

91.

(6X8) - Fixed bridge, brackets to

include abutments:

15°

16

18

THERE

(Continue in item 73)

CEROX

-REMARKS.

AND-ADDITIONAL

DEFECTS AND DISEASES

DENTALI

- TypellARS in

Class

-2

Qualified

• 31

29

26

25

Prosthesis serviceable

LABORATORY FINDINGS.

45. URINALYSIS: A. SPECIFIC GRAVITY

B. ALBUMIN

Neg

C. SUGAR

Neg

47. SEROLOGY (Specify lest used and resull).

VDRI: - Nee

1.020

D. MICROSCOPIC

Essentially Negative

48. 'EKG

49, BLOOD TYPE AND RH

FACTOR

WNL

10c50 Pos

DAti

record

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

838 TAC HOSPITAL, FORBES AFB, KANSAS

Film 2705 Neg (14x17) 10 Apr 62

50. OTHER TESTS.

Hematocrit 46%

49

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