Agency: FBI
Originator: FBI
From: KC
Document date: 10/13/1978
Document type: PAPER, TEXTUAL DOCUMENT

## Page 1

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

DATE: 11-14-2017

JFK Assassination System

Identification Form

5/27/201

Agency Information

AGENCY :. FBI

RECORD NUMBER :

124-10132-10136

RECORD SERIES :

HQ

AGENCY FILE NUMBER : 67-494012-224

Document Information

ORIGINATOR:

FROM:

FBI

KC

TO:

TITLE :

DATE: 10/13/1978

PAGES:

11

SUBJECTS :

JAMES P. HOSTY JR.

DOCUMENT TYPE :

PAPER, TEXTUAL DOCUMENT

CLASSIFICATION: Unclassified

RESTRICTIONS:

3

CURRENT STATUS :

Redact

DATE OF LAST REVIEW :

10/06/1998

OPENING CRITERIA: INDEFINITE

COMMENTS: MED RPT, INC FD-300, MED SLIPS, CARDIOGRAM, EXAM

v9.1

DocId: 32284558

2

Page 1

---

## Page 2

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

Revised April 1968

General Services Administration

FPS201-11-309-5n Medical Records

VELAST NAME - FIRST NAME- MIDDLE NAME

JAMES P.

-HOME-ADDRESS (Number, street or REDnely or town, Stale and ZIP Code)

30/44151

1rr

66205

Mali

12: DATE OF BIRTH'.

8. RACEY

White

13. PLACE OF BIRTH

9. TOTAL YEARS GOVERNMENT SERVICE

MILITARY

CIVILAN 27

REPORT OF MEDICAL EXAMINATION

2. GRADE AND COMPONENT OR POSITION

F. B. I

5. PURPOSE OF EXAMINATION

3. IDENTIFICATION NO.

739 Lin.

6. DATE OF EXAMINATION

130ct1978

28 any: 1474

Chicago

15. EXAMINING FACILITY OR EXAMINER. AND ADDRESS

Iel

Annual

10. AGENCY

11. ORGANIZATION UNIT

FBI.

KANSAS

C.IT.Y

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

JANETE HOSTY (WIFE)

sume

16. OTHER INFORMATION

: 17: RATING OR SPECIALTY

TIME IN THIS CAPACITY (Total)

LAST SIX MONTHS

CLINICAL EVALUATION

NOR-

MAL

mck each losin

appropriate col-

it not evaluated.)

NOTES.

(Describe ever

abnormality in detail.

comment.

ontinue in item 73 and use addipional sheets i necessery.

ABNOR;

number bofore each

MAL.

18. HEAD. FACE. NECK. AND SCALP

- 19. NOSE

- -20. SINUSES: -

"21. MOUTH, AND THROAT

22. EARS-GENERAL

(Int. de est. cancis) (Auditory

scuity under items! 70 and ?!)

....23. DRUMS (Perforalion)

24. 'EYES-GENERAL '(Visual acuily and refraction

under ilems.59, 60 and 62)

.25. OPHTHALMOSCOPIC

26. PUPILS (Equality and reaction)

REC-143

67-2

Searched..

=224

27. OCULAR MOTILITY (Associaled

parallel move-

ments, mustaomus)

28. LUNGS AND CHEST (Include breasts)

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

. ENCLOSURE

... Numbered

1

OCT 30 1978

30. VASCULAR SYSTEM (V'aricosities, elc.)

-3T. ABDOMEN AND VISCERA (Include hernia)

2. ANUS-AND RECTUM (Hemorrhoid

fatular)

Torture, e thercare

133. ENDOCRINE SYSTEM

34. G-U SYSTEM

L35. UPPER EXTREMITIES (Strenor, range of

moron.

Priviliani -

candal a

praithlismull finith

War-nadult

abraphy it Kertile

36. FEET

(Except feet)

37. LOWER EXTREMITIES (Strenoth. range of motion)

-38. SPINE. OTHER MUSCULOSKELETAL

39. IDENTIFYING BODY MARKS. SCARS, TATTOOS

70. SKIN, LYMPHATICS

-AT. NEUROLOGIC (Equilibrium tests under item 72)

•A2:" PSYCHIATRIC (Specilvany personality deviation)

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

VAGINAL |

• RECTAL

14. DENTAL (Place appropriate symbols, shown in examples, above or below number of upper and lower teeth. )

XEROX

1980

(Continue in item 73)4

REMARKS AND ADDITIONAL DENT.

PFECTS AND DISEASI

HAR

32 31 36 Resurible

teeth

"her

31

30

29

28

Non-:

3o restoruble

leth.

27

26

32

3ỉ 30

Missing

reeth

10

25

24

23

7 3 38

Replaced

dentures

11

12

13

22

21

20

14

19

LABORATORY FINDINGS

15

18

E

45. URINALYSIS: A: SPECIFIC GRAVITY

B. ALBUMIN

C. SUGAR

47. SEROLOGY (Specify lest used and result)

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

D. MICROSCOPIC

48. EKG

9. BLOOD TYPE AND RI

50. OTHER TESTS

ACTOS

SNOV 6

88-116

DocId: 32284558 Page 2

---

## Page 3

Released under the John E. Kennedy Assassination Records Collection BE i3

441 USC 2107 Mote).

ПОТЕ: 11-11-2017

MEASUREMENTS AND OTHER FINDINGS

51. HEIGHT

13

57.

223

BLOOD PRESSURE (Arm at heart leoel)

53. COLOR HAIR

Black

SAERORENEL

56. TEMPERATURE

Коши

MEDIUM

sYs//Y

SITTING

DIAS. 70

RECUM-

BENT

59.

RIGHT 20/

LEFT 20/

DISTANT VISION:

30

CORR. TO 20/

20

30

• CORR. TO 201 20

62. HETEROPHORIA (Specify distance)

D. RECUMBENT E.

AFTER STANDING

60)

NEAR VISION

BY. 12)

BY T-25

S.

Cx

CX

CORR. TO

-

г/н

BY 7/. 22

ES°

EX°

R. H.

L. H.

PRISM DIV.

PRISM CONV.

CT

PC

PD

63.

RIGHT

66. FIELD OF VISION

ACCOMMODATION

LEFT

64. COLOR VISION (Test used and result)

200 Cren Cha

67. NIGHT VISION (Test used and score)

DEPTH PERCEPTION

(Test used and score) :

11010l

68: RED LENS TEST

UNCORRECTED

CORRECTED

69. INTRAOCULAR TENSION

70.

HEARING

71. :

AUDIOMETER

72. PSYCHOLOGICAL AND PSYCHOMOTOR

(Tests used and score)

RIGHT WV

/15 SV

/15

$56

LEFT WV

/15 SV

/15

RIGHT

LEFT

5

5

73. NOTES (Continued) AND SIGNIFICANT OR INTERVAL HISTORY

500

5

5

1000

5

2000

3000

1000

5

15%

30

35

65

6000

30

50.

(Use additional sheets if necessary)

TA, SUMMARY OF DEFECTS AND DIAGNOSES (LiA diagRancE Will it mders)

Xian.

anu tongue

75. RECOMMENDATIONS-FURTHER SPECIALIST EXAMINATIONS INDICATED (Specify)

T7: EXAMINEE (Cheik)..

A. O IS QUALIFIED. FOR

BUTS NOT QUALIFIED FOR

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

IPES OR PRINTED NAME OF PHYSICIAN.

80. TYPED OR PRINTED NAME OF PHYSICIAN

mos

Williams

DDS

J1. TYPED OR PRINTED NAME OF DENTIST OR PHYSICIAN (Indicate which

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

SIGNATURE

76.

A. PHYSICAL PROFILE

B. PHYSICAL CATEGORY

dilige

SIGNATURE

NUMBER OF AT.

TACHED SHEETS

-2

# U.S. GOVERNMENT PRINTING OFFICE: 1969 0-352-273 149J)

DocId: 32284558 Page 3

---