Agency: FBI
Originator: FBI
From: KC
Document date: 05/24/1971
Document type: PAPER, TEXTUAL DOCUMENT

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

DATE: 11-14-2017

JFK Assassination System

• Date:

5/27/201

Identification Form

Agency Information

AGENCY: FBI

RECORD NUMBER :

124-10134-10442

RECORD SERIES:

HQ

AGENCY FILE NUMBER : 67-494012-181

Document Information

ORIGINATOR: FBI

FROM:

KC

TO:

TITLE :

DATE: 05/24/1971

PAGES:

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: 32285166

21

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

DATEderaTon ds 2017

Revised April 1968

General Services Administration

Interagen, Come. on Medical Reçords

ERM RIAR,

-$1.803-3

LAST.NAME-FIRST NAME-MIDDLE NAME

HESTY

James Patrick,

JI.

HOME ADDRESS (Number, street or RFD, cily or lown, State and ZIP Code)

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

3014 W. 51st Terrace

Shawnee-Mission Kansas

7. SEX

8. RACE

Male

Caucasian

66205

9. TOTAL YEARS GOVERNMENT SERVICE:

MILITARY 3

CIVILIAN

Annual

24 May 71

17

12. DATE OF BIRTH

13. PLACE OF BIRTH

(46)

28 Aug

24

Chicago, Ill

15. EXAMINING FACILITY OR EXAMINER, AND ADDRESS

10. AGENCY

11. ORGANIZATION UNIT

FBI

Kansas City

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

Janet P.

Hosty (Wife)

Same as

$F4

16. OTHER INFORMATION

USAF Hosp, Richards-Gebaur (EFCS) R-G AFB Mo

17: RATING OR SPECIALTY

TIME IN THIS CAPACITY (Total)

LAST SIX MONTHS

CLINICAL EVALUATION

MAI

X

X

(Check

umn; enter

NOTES: (Describe every abnormality

ABNOR

comment.

in detail.

Enter pertinent item number before each

Continue in

and use additional sheets if necessary.)

HAL

18. HEAD, FACE, NECK, AND SCALP

19. NOSE

20. SINUSES

21. MOUTH AND THROAT

21. Tonsils enucleated.

22. EARS-GENERAL

m sext, canals) To udiory,

acuity under items 70 and

23. DRUMS (Perforation)

X

X

24.

EYES-GENERAL

(Visual acuity

and refraction

under items 59, 60 and 67)

25. OPHTHALMOSCOPIC

26. PUPILS (Equality and reaction)

X

27. OCULAR MOTILITY (Associated parallel move-

ments, nystagmus)

28. LUNGS AND CHEST (Include breasts)

X

X

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

30.. VASCULAR SYSTEM (Varicosities, etc.)

31. ABDOMEN AND VISCERA (Include hernia)

XEROX

X

X

32. ANUS AND RECTUM

(Hemorrhoids,

Fistulae)

(Prostate, if indicated)

33. ENDOCRINE SYSTEM

34. G-U SYSTEM

34. Circumcised, WHNS.

35. UPPER EXTREMITIES (Strength, range of

X

X

36. FEET

37. LOWER EXTREMITIES (Except feet)

(Strerigth, range of motion)

38. SPINE; OTHER MUSCULOSKELETAL

39. IDENTIFYING BODY. MARKS, SCARS, TATTOOS

X

38.

39.

REC-133

onintected m

Scar 1"', mic

WHNS

40. SKIN, LYMPHATICS

X

X

41. NEUROLOGIC (Equilibrium tests under item 72)

1971

42. PSYCHIATRIC(Specify any personality deviation)

43. PELVIC (Females only)

(Check how done)

I VAGINAL RECTAL

lue in item 73)

44. DENTAL (Place appropriate symbols, shown in examples, above or below number of upper and

tong

er-teeth.).

REMARKS AND ADDITIONAL DENTAL

DEFECTS AND DISEASES

oorn

1507 15.

Replaced

Fixed

Partial*

32 31

30

dentures

32

31 30 dentures

Exam

type 3

Dental Class

2

7

13

20

14

19

15

18

17

LABORATORY FINDINGS

45. URINALYSIS:

A. SPECIFIC GRAVITY

1.025

D. MICROSCOPIC

Negative

47. SEROLOGY (Specify test used and result) 48. EKG

RPR-Neg

49. BLOOD TYPE AND RH

Normal

"O"Pos

(by

record)

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

14 x 17 Film, No 71-5267

R-G AB Mo

24 May 71

Normal

Hémat: 45 vols%

88-117-01

59

JUN 141971

DocId: 32285166

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