Agency: FBI
Originator: FBI
Document date: 02/20/1964
Document type: PAPER, TEXTUAL DOCUMENT

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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: 124-10134-10312

RECORD SERIES :

HQ

AGENCY FILE NUMBER: 67-494012-116

Document Information

ORIGINATOR: FBI

FROM:

TO:

TITLE:

DATE: 02/20/1964

PAGES:

7

SUBJECTS :

JAMES P. HOSTY JR.

DOCUMENT TYPE: PAPER, TEXTUAL DOCUMENT

CLASSIFICATION: Unclassified

RESTRICTIONS : 3

CURRENT STATUS : Redact

DATE OF LAST REVIEW: 08/21/1998

OPENING CRITERIA: INDEFINITE

COMMENTS: MED RPT, INC LET, MED HISTORY, FD-300

V9.1

DocId: 32285036

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Page 1

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

DATE; 11-14-2017

Standard Form 88

(Rex.

June. 1956)

88-103-01

1: L9ST NAME -FIRST NAME-MIDDLE NAME

HOSTY,

JAMES PATRICK

JR

4. HOME ADDRESS (Number, streel or RFD, city or lown, zone and Stare)

11018 Genetta Dr, Dallas, Texas

RT OF MEDICAL EXAMINATION

2. GRADE AND COMPONENT OR POSITION

SPECIAL AGENI

5. PURPOSE OF EXAMINATION

Annual

3; IDENTIFICATION NO.

6. DATE OF EXAMINATION

20 Feb 64

7. SEX

Male

12. DATE OF BIRTH

B. RACE

White

13. PLACE OF BIRTH

9. TOTAL YEARS GOVERNMENT SERVICE

MILITARY

3

CIVILIAN.

12

10. AGENCY

11. ORGANIZATION UNIT

• FBI

Dallas, Tex

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

Janet P Hosty

(wife)

(Same as Item 4o)

28 Aug 24 (39)

Chicago, Illinois

15, EXAMINING FACILITY OR EXAMINER. AND ADDRESS

USAF HOSP CARSWELL, CAFB, TEXAS

17 RATING OR SPECIALTY.

16, OTHER INFORMATION

TIME IN THIS. CAPACITY: (Total)

LAST: SIX MONTHS:

CLINICAL EVALUATION

NOTES. ¡Describe

add details fats i perissay, irom number botara dach command

NOR-

MAL

(Chock soch iNem

appropriate

it nop evaluate dol

columns

ABNOR-

MAL

18.

HEAD. FACE, NECK. AND SCALP

19.

NOSE

20.

SINUSES

21.

MOUTH AND

THROAT

'22.

EARS- GENERAL (Int. &

ext.

acuity under

items 70 and

23.

DRUMS (Perforation)

24. EYES-GENERAL (Visual

undef

acuis, do and tien

25. OPHTHALMOSCOPIC

26: PUPILS (Equality and reaction)

27.. OCULAR MOTILITY (Associaled

parailor more.

ments,

nystagmus)

28: LUNGS AND CHEST (Include breasts)

REC-139

Weerched

494 012-116

KniTiored

O MAR 23:1964

29. "HEART (Thrust, sizo, rhythm, sounds):

30.

VASCULAR SYSTEM (Varicosities, etc.)

ABDOMEN AND VISCERA (Include hornia)

32.

ANUS AND RECTUM

(Hemorrhoids, fistulae)

indicoled)

33.

ENDOCRINE SYSTEM

34.

G-U SYSTEM

35.

340. Right testes, not palpable.

UPPER 'EXTREMITIES

(Strength, range of

morton.

36.

19171

37.

LOWER EXTREMITIES (Excepf feet)

(Strength, range of motion)

38.

SPINE, OTHER NUSCULOSKELETAL

39.

IDENTIFYING BODY MARKS, SCARS, TATTOOS

40. SKIN. LYMPHATICS

41.

NEUROLOGIC (Equilibrium tests under item 72).

x

42.

PSYCHIATRIC (Specify any personality derialion)

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

39. I" horizontal scar of forehead, WHINS DR T duc

40. I" x 1/4" hemangtonagi left posterior chest.

PENCLOSUL

I VAGINAL

• RECTAL

• (Continue in item 73)

4A. DENTAL (Place appropriate symbols abore or below

number of upper and lower leeih, respectively.)

REMARKS AND

ADDITIONAL DENTAL

DEFECTS AND DISEASES

O-Restorable teeth

I- Naprestorable tooth

R

XXX-Missing toeth

_ Replaced by dentures

16 x 81- Fixed bridge, brackets to

include

abutments -

130

33x

31

30

29

28.

27

26

25

24

10

23.

22

12

21

13.

14.

15.

Type 3., Class 1.

20

19

18

LABORATORY FINDINGS

A9. URINALYSIS: A. SPECIFIC GRAVITY

B. ALBUMIN

Neg

C. SUGAR

Neg

47. SEROLOGY (Specity lest used and result)

1.027

D. MICROSCOPIC

Within normal limits.

48. EKG

SLOOS

BH DA TORE ANE

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

CAFB, Tex

#64-3379

20 Feb 64

Negative

SO. OTHER TESTS

Cardiolipin - Negative

Atchd,

Normal

3%

11504

ano

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Released under the JoIn F. Kennedy Assassination Records Collection Act of 1992 744 USC 2107 Note) -

DATE: 11-14-2017

51: HEIGHT

72

52, WEIGHT

183

57.

BLOOD

PRESSURE (Arm

at heart level)

A.

SYS.

110

B.

SYS.

C.

SITTING

DIAS.

70

RECUM-

BENT

DIAS.+

STANDING

(3 min.)

59.

DISTANT VISION

60.

RIGHT 20/

20

CORR. TO 201

BY

LEFT 20/

20

CORR. TO 201

BY

62. HETEROPHORIA (Specify distance)

MEASUREREATS AND OUTER FINDiGa

53. COLOR HAIR

54. COLOR EYES

55. BUILD:

DJ SLENDER

• MEDIUM ] HEAVY I OBESE

56. TEMPERATURE

98

SYS.

DIAS. +

58.

A. SITTING

64

REFRACTION

PULSE (Arm al heart level)

B. AFTER EXERCISE TC. Z MIN. AFTER

D. RECUMBENT |E. AFTER STANDING

3 MIN.

76

72

S.

ox

61.

NEAR VISION

20/20

CORR. TO

20/20

CORR. TO

-

BY

BY

ES°

EX°

R. H.

L. H.

PRISM DIV.

63.

RIGHT

66. FIELD OF VISION

ACCONMODATION

LEFT

PRISM CONV.

Fing

55. DEPTH PERCEPTION

Test used and score

PC

PD

64. COLOR VISION (Test used and result).

VTS-CV

Passed

67. NIGHT VISION (Test used and score)

68: RED LENS TEST

Normal

70.

HEARING

71.

UNCORRECTED

-

CORRECTED

69. INTRAOCULAR TENSION

Normal

72. PSYCHOLOGICAL AND PSYCHOMOTOR

(Test used and score)

RIGHT WV

15 /15 SV

/15

Maico

250

256

500

512

1000

1024

AUDIOMETER

2000

2048

3000

2896

4000

4096

6000

5000

RIGHT

LEFT WU 15 /15 su

- 115

LEFT

13 20

10

20

73. NOTES (Continued) AND SIGNIFICANT OR INTERVAL HISTORY

Whooping cough in childhood; no comp, no sega

Laceration to forehead in early childhood; no comp, no sea.

Denies all other medical or surgical history.

(Use additional sheels if necessary)

TA. SUMMARY OF DEFEGTS AND DIAGNOSES (List diagnoses with item numbers)

-

75. RECOMMENDATIONS-FURTHER SPECIALIST EXAMINATIONS INDICATED (Specify)

Refer to private physician for evaluation of right testes.

77. EXAMINEE (Check)

AXE] IS QUALIFIED FOR

Arduous duties.

B. [J IS NOT QUALIFIED FOR

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

79. TYPED OR PRINTED NAME OF PHYSICIAN

ALBERT B HENRY, CAPT, USAF, MC

BO. 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

SIGNATURE

SIGNATURE

SIGNATURE

SIGNATURE

76.

A. PHYSICAL PROFILE

B. PHYSICAL CATEGORY

A

NUMBER OF AT-.

TACHED SHEETS

# U.S. GOVERNMENT PRINTING OFFICE: 1960-537859

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