Agency: FBI
Originator: FBI
Document date: 12/28/1951
Document type: PAPER, TEXTUAL DOCUMENT

## Page 1

Released under the John T. Kernedy 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 :

124-10193-10494

RECORD SERIES: HQ

AGENCY FILE NUMBER :

67-494012-11

Document Information

ORIGINATOR:

FBI

FROM:

TO:

TITLE:

DATE:

PAGES:

SUBJECTS:

12/28/1951

3

JAMES P. HOSTY JR.

DOCUMENT TYPE :

PAPER, TEXTUAL DOCUMENT

CLASSIFICATION:

Unclassified

RESTRICTIONS:

3

CURRENT STATUS : Redact

DATE OF LAST REVIEW :

08/18/1998

OPENING CRITERIA:

INDEFINITE

COMMENTS :

SF-88

v9.1

DocId: 32285718

Page 1

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## Page 2

„under the John F. Kennedy Assassination Records Collection Act of 1992 (11 USC 2107 Hote) .

11-14-2017

„ Standard Form 88

-REPORT

OF MEDICAL EXAMINATIN

I LASTLEME FIRST- NAME MIDDLE NAME-

LAMES

E ADDRESS. (0i26770er,-street or RED, cuty or town, 2011e.and State)

2633% LINCOLNWAY W.

2. GRADE AND COMPONENT OR FOSITION

3. IDENTIFICATION NC.

ATRICK

MISHAWAKA, IND

INTERANCE

4-10. DEPARTMENT. AGENCY, OR SERVICE

ARMY

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

6. DATE OF EXAMINATION

peric.

-13. PLACE OF BIRTH

AVG: 28 1924

CHICAGO, ILL

15. EXAMINING FACILITY OR EXAMINER, AND ADDRESS

Wendell Esparding MD.

17. RATING OR SPECIALTY-V

CLINICAL

EVALUATION

ABNOR-

NORMAL

MAL

(Check each item in appropriate col-

16. OTHER INFORMATION

mishawake Red

i.sx

TIME IN THIS CAPACITY: TOTAL

LAST SIX MONTHS

NOTES. --Describe every abnormality in detali.

(Enter pertinent ion ruerber, before each

comment: continue in item 73 and use additional shoots if necassery.)

umn: enter "N.

E.

if not evaluated)

18. HEAD, -FACE, NECK, AND SCALP

19. NOSE

20. SINUSES

21. MOUTH AND THROAT

22. EARS-GENERAL (Int. & ex6, canis) isdilory

acuity under item. 70 and 71)

23. DRUMS (Perforation)

(Fisual

acuity

and refraction.

4. EYES- GENERAL under items 59, 60, and 61)

25. OPHTHALMOSCOPIC

..:T

26. FUPILS (Equality and reaction)

27. OCULAR MOTILITY

(Asancinted parallel more-

menta. nystagmue)

28. LUNGS AND CHEST (Include brcasts)

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

50. VASCULAR SYSTEM (Varicosities, ete.)

31. ABDOMEN AND VISCERA (Include hernia)

(Memorrhoida, fistulae)

32. ANUS AND RECTUM (Prostate if indicated)

33. ENDOCRINE SYSTEM

34. G-U SYSTEM

35. UPPER EXTREMITIES (sirengih, range of

atroply at testiall

36. FEET

37. LOWER EXTREMITIES

(I'ncept ject)

(Strenoth.range of notion)

36. SPINE, OTHER MUSCULOSKELETAL

39: IDENTIFYING BODY MARKS, SCARS, TATTOOS

40. SKIN, LYMPHATICS

41, NEUROLOGIC (Faulibrium tesis under item 72)

42, PSYCHIATRIC (Specify ansi personality deviation)

XEROX

HI 1980

Fomales only

(Check how done) "

43: PELVIC

I VAGINAL - L RECTAL:

44. DENTAL (Place appropriate sumbols above or below number of upper and lower teeth, respectively)

0.-Restorable teeth.

X.- Missing teeth

0: 1.- Nonrestorable teeth

XXX.- Replaced by dentures ...

(6X8).- fied bridge, Brackets to

, (Continue in item 73)

REMARKS AND ADDITIONAL DENTAL DEFECTS AND

DISEASES, i>

include abutments

T2 Deci

4

5

61?.: 8,

...I

10 : .11+)

12

1314

• 15

16

32.

31 1 30 0

29

28

•"27". . 26

25

24

23 ... 22

21

20

119

E

17.. T

67- 494013-1,

sosioned

Numbered

45. URINALYSIS:

SP. GR.

ALBUMIN*

"SUGAR

ноже

Rosi

48: EKG

1,020

MICROSCOPIC

negati

49. BLOOD TYPE AND RH

FACTOR

LABORATORY FINDINGS

46, CHEST X RAY (Place, date, thm number, reoul

not dose

50. OTKER TESTS

reg. Naggeres

1952

nore

MAR 10 1980

11 JAN 14 1952

16 922885

DocId: 32285718 Page 2

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## Page 3

Released under

the John F. Kennedy Assassination Records Collection Ag

DATE: 01-41÷2017120

193-0494

3 1056

51. HEIGHT

G'112"

57. BLOOD PRESSURE (Arm at heart level)

I SYS: 1370

52. WEIGHT

228263

MEASUREMENTS AND OTHER FINDINGS

53. COLOR HAIR

Black.

54. COLOR EYES

55. BUILD:

lessese

58, PULSE (Arm at heart level)

STANDING

(3 min.)

"SYS. 134

SITTING •

AFTER EXERCISE

64

100

SLENDER MEDIUM MEGY OBESE

56. TEMP.

98.4°

-2 MIN: AFTER

64

RECUMBENT

AFTER STANDING

3 MIN. 6 8

59: ,

RIGHT 20/ 20

'LEFT 20/-

20

62. HETEROPHORIA:

(Specify distance)

63. ACCOMMODATION

RIGHT

oxe

66. FIELD OF VISION

-CORR: TO 2L B: 1

* 60:

BY

_CORR. TO 20/

"S.--

BON APPLICANT DINI

.L. H.

FA: COLOR VISION, (Tet used end rest)

LEFT

ted in

DAN

48T NiGHE VISION (Tet tised and score)

REFRACTION

cx

CX

PRISM DIV.

61.

NEAR VISION

REC EAR. TO

PERSONNELCON?

Vi

JAN

PC

BY

BY

PD

70.

RIGHT WY I

LEFT WV.

HEARING

71.

• AUDIOMETER

65. DEPTH PERCEPTION

UNCORRECTED

23 AM

(Test used fed score)

68. RED LENS

5. DEPT. P. Sier

69. INTRAOCULAR TENSION

72. PSYCHOLOGICAL AND PSYCHOMOTOR (Teste used and score)

250

256,

1000

1024

2010

3000

2898

4000

40.96

8000

8199

/15 SV

15 SY

415

*/15

RIGKT

LEFT

73. NOTES (Continued) AND SIGNIFICANT OR INTERVAL HISTORY-

none

(Use additional sheets of plain paper if necessary) .

74. SUMMARY OF DEFECTS AND DIAGNOSES (List diagnoses with item numbers)

atrophy it testicle

75. RECOMMENDATIONS- FURTHER SPECIALIST EXAMINATIONS INDICATED (Specify)

76.

PHYSICAL PROFILE

U-

77. EXAMINEE (Check)

IS NOT QUALIFIED FOR

78. 1F NOT QUALIFIED, LIST DISQUALIFYING DEFECTS BY ITEM NUMBER

PHYSICAL CATEGORY

79. TYPED OR PRINTED NAME OF PHYSICIAN

WENDELL

"SPALDiNG.;

80. TYPED OR PRINTED NAME.OF PHYSICIAN*

MID

SIGNATURE-

SIGNATURE

Wendult Aparding MD.

*.

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

SIGNATURE -

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

SIGNATURE

NUMBER OF AT-

TACHED SHEETS

U. S. GOVERNICENT PRINTING OFFICE

16-82288-1

DocId: 32285718

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