Originator: FBI
From: DL
Document date: 02/21/1962
Document type: PAPER-TEXTUAL DOCUMENT

## Page 1

JFK Assassination System

Identification Form

Agency Information

Date:

5/27/201

AGENCY: FBI

RECORD NUMBER :

124-10134-10273

RECORD SERIES: HQ

AGENCY FILE NUMBER :

67-494012-102

Document Information

ORIGINATOR: FBI

FROM: DL

TO:

TITLE :

DATE: 02/21/1962

PAGES: 6

SUBJECTS :

JAMES P. HOSTY JR.

DOCUMENT TYPE: PAPER, TEXTUAL DOCUMENT

CLASSIFICATION: Unclassified

RESTRICTIONS: Open in Full

CURRENT STATUS:

Redact

DATE OF LAST REVIEW: 08/20/1998

OPENING CRITERIA: INDEFINITE

COMMENTS: MED. RPT, INC FD-300, MED RPT

19.1

DocId: 32284997

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## Page 2

-

S Standard Form

(Rex.

Jone

8956)

88-109-01

REPORT OF MEDICAL EXAMINATIO

1. LAST NAME-FIRET NAME-MIDDLE NAME

OSty

James

Patrick

4. HOME ADDRESS (Number, strool. or RFD, city or town, zone and State)

11018 Genetta Dr.

Dallas 28

Texas

7. SEX

18. RACE

Male

White

9. TOTAL YEARS GOVERNMENT SERVICE

MILITARY 3

CIVILIAN

12. DATE OF BIRTH

13, PLACE OF BIRTH

10

2. GRADE AND COMPONENT OR POSITION

3. IDENTIFICATION NO.

Special Agent

7392

5. PURPOSE OF EXAMINATION

6. DATE OF EXAMINATION

28

Aug

24(37)

Chicago,

Illinois

15. EXAMINING FACILITY OR EXAMINER, AND ADDRESS

Annual

10. AGENCY

21 Feb 62

11. ORGANIZATION UNIT

FBI

Dallas

Texas

8. NAME, RELATIONSHIP, AND ADDRESS NEXT RES

Janet Perry Hosty (Wife)

Same as item 4.

1G. OTHER INFORMATION

USAF HOSPITAL CARSWELL, CAFB, TEXAS

17. RATING OR SPECIALTY

TIME IN THIS CAPACITY (Total)

LAST SIX MONTHS

NON-

_Mat

_8

23.

CLINICAL EVALUATION

(Chock easte ito

* not it i or ore alumn,

18, HEAD, FACE: NECK, AND SCALP

19. NOSE

20. SISUSES

28. MOUTH AND THROAT

22. EARS - GENERAL (Int.

exhi

ervily undes

fever: 70

and

29. DRUMS (Perforation)

24, EYES- GENERAL

(Visual

scally

and.

refraction

inder Heme 59,60 and 67)

25.

OFHTHALMOSCOPIC

VOTES. (Describe

ABNGR-

ality

addite it stal i pretins, ieem number before each comment.

PEC-131

ENCLOSURE att

26.

PUPILS (Equality and reaction)

27. OCULAR MOTILITY

(Associanas catalial more.

menis, myrtogers)

28. LUNGS AND CHEST (Include breasts)

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

30.

VASCULAR SYSTEM (Voricositles, elc.)

31. ABDOMEN AND VISCERA (leclude hernia)

32.

ANUS AND RECTUM

(Hemoriboids, fistulae)

(Prostate,

if indicated)

за.

ENDOCRINE SYSTEM

31.

Prominent bulage,

right inguinal region,

no bernia, NS.

S4, G-U SISTEN

34.

Atrophy of right

testis, NS.

35.

UPPER EXTREMITIES

(Strengta, range of

Meront

36. FEET

37, LOWER EXTREMITIES (Except fai)

(Strengih, ronge of motion)

38.

SHINE.

OTHER MUSCULOSKELETAL

39.

IDENTIFYING. BODY MARKS, SCARS, TATTOOS

39.

40.

SKIN, LYMPHATICS

41.

NEUROLOGIC (Equilibrium tests under ilem 72)

42. PSYCHIATRiC (Spacity ony persocality deviation)

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

• VAGIRAL

I RECTAL.

44. DENTAL (Place appropriate symbols abore or belov

number of upper and lower loath, respectivoly.)

REC-131

67. 494012-103

Searched

Numbered

" horizontal scar, let MAR 2I OLD

forehead, WINS.

THREE DON

(Continue in item 73)

REMARKS AND ADDITIONAL DENTAL

DEFECTS AND DISEASES

O- Restorable teeth

1- Nonrestorable feath

R

1*21

32

31

30

X-Missing leeth

XXX-Replaced by dentures

24

29

3

28

6

27

10

26

251

24

23

11

22

12

20

(6 X 8) -fized bridge, brockels lo

include abularents

13

14

15

E

20

19

18

175

Type 3, Class 1.

LABORATORY PINDINGS

45. URINALYSIS: A, SPECIFIC GRAVITY

B. ALBUMIN

deg

C. SUGAR

Neg

47. SEROLOGY (Specity test used and resull)

1.018

D. MICROSCOPIC

48. EKG

49.

BLOOD TYPE AND

RH FACTOR

46. CHEST PRAY (Place,.

CAFE, Texas

702-32031

50, OTHER TESTS

ig ymber and resul)

2 Feb 62

Negative

Cardiolie

Nee

ArNO

1362

Atchd

/normal

DocId: 32284997

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