Agency: FBI
Originator: FBI
From: KC
Document date: 8/1/75
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

Date:

5/27/201

Identification Form

Agency Information

AGENCY: FBI

RECORD NUMBER: 124-10134-10486

RECORD SERIES: HQ

AGENCY FILE NUMBER: 67-494012-202

Document Information

- ORIGINATOR: FBI

FROM:

KC

TO:

TITLE :

DATE:

PAGES:

SUBJECTS :

08/01/1975

JAMES P. HOSTY JR.

DOCUMENT TYPE: PAPER, TEXTUAL DOCUMENT

CLASSIFICATION: Unclassified

RESTRICTIONS: 3

CURRENT STATUS : Redact

DATE OF LAST REVIEW: 08/31/1998

OPENING CRITERIA: INDEFINITE

COMMENTS:

MED RPT, INC FD-300

v9.1

DocId: 32285210

26

Page 1

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## Page 2

Released under

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

IS TEardkorn1882017

Kevised April 1968

General Services Administration

Interagençy Comm. on Medical Records

REPORT OF MEDICAL EXAMINATION

14 LAST NAME- FIRST NAME- MIDDLE NAME

AHOSTY

JAMES

PATRICK...

4. HOME ADDRESS (Number, street or RFD, city or town, Stale and ZIP Code)

Sharonce

arcasion

Is 66205

9. TOTAL YEARS GOVERNMENT SERVICE

MALE:"

CIVILIAN: 2:3

• GRADE AND COMPONENT OR POSITION

1.611:1

5. PURPOSE OF EXAMINATION

3. IDENTIFICATION NO.

teRed 354-16-1823

6. DATE OF EXAMINATION

Annual.

11. ORGANIZATION UNIT

- BI

KAWAS CITY

: NEXT OF KIN

TA NAME RELATIONSHIP AN ARSEHO STY (LOITE)

VANET

28AUG 1924

Chicago,

Ill

OR EXAMINER. AND KODRESS

USAF Richards Bebear. AFB Mo 64030

17. RATING OR SPECIALTY

16." OTHER INFORMATION

354-16-1873

TIME IN THIS CAPACITY (Tolal)

LAST SIX MONTHS

CLINICAL EVALUATION

NOTES.

NOR-

MAL

cock enter inti

appropriate col-

TABNOR-

it not evalurted.)

MAL

18. HEAD. FACE, NECK. AND SCALP

19. NOSE

21. TONsils Enucleated

20

SINUSES

21. MOUTH AND THROAT

22. EARS'- GENERAL (Int. de est, condia! (Auditori

suity under ilema 70 and 71)

23. DRUMS (Perforation)

24. EYES-GENERAL IVieral amules od refraction

25. OPHTHALMOSCOPIC

26. PUPILS (Equality and reaction)

•:E:

27. OCULAR MOTILITY (Associated

poratter move.

ments, austagmus)

28. LUNGS AND CHEST (Include breasts)

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

30. VASCULAR SYSTEM (Varicosities, etc.)

31. ABDOMEN AND VISCERA (Include hernia)

32. ANUS AND RECTUM

(Hemorrhoids, fistular)

(Prostate, if indicated)

33. ENDOCRINE SYSTEM

34. G-U SYSTEM

35. UPPER EXTREMITIES I trenoth, range of

motion)

36. FEET

(Except feet)

34. Circu

¡ENCLOSURE

37. LOWER EXTREMITIES (Strength, range of motion)'

38. SPINE. OTHER MUSCULOSKÉLETAL

39. IDENTIFYING BODY MARKS. SCARS, TATTOOS

40. SKIN, LYMPHATICS

41.

NEUROLOGIC (Equilibrium teale under item 72)

42. PSYCHIATRIC (Specify ano personalitu devistion.)

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

[VAGINAL RECTAL.

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

the 3, 3 Peerible

Non-

reeth

31

3 restorable

i do Missing

Replaced

by

teeth

teeth.

dentures

(Continue in itom 73)

32 3i 3ở

'Fixed

Partial

dentures

portinent item

number before each

67. 494812-202

REC-145

Searched

1UG, 28 1975

REMARKS AND ADDITIONAL DENTAL,

DEFECTS AND DISEASES

Class

Qualified

45. URINALYSIS: A. SPECIFIC GRAVITY 1.020

B. ALBUMIN

N24

C. SUGAR

Nea

47. SEROLÖGY (Specify testased and result)

D. MICROSCOPIC

LABORATORY FINDINGS

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

75-C677

BLOOD TYPE AND RH

B/R

Nornia

O pos

Лопта

50. OTHER TESTS

At 45%0

RPR-NO

SEP 5

1975}

88-116

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## Page 3

(Released

FATE? 11-1-201

51. HEIGHT

13

S2. WEIGHT

John F. Kennedy Assassination Records Collection Act 05497344DUSc 2107 Note).

MEASUREMENTS AND OTHER FINDINGS

S4. COLOR EYES

55, BUILD:

53. COLOR HAIR

56. TEMPERATURE

57.

309

BLOOD PRESSURE (ATT al heart level).

A.

SITTING

SYs.j02

B.

SYS.

58..

A. SITTING

RECUM-

SLENDER

MEDIUM

XI HEAVY

OBESE

PULSE (Arm at heart leDel)

B. "AFTER EXERCISE C. 2 MIN. AFTER

D. RECUMBENT

E. AFTER STANDING

3 MIN.

DIAS, 28

BENT

DIAS.

59.

DISTANT VISION

RIGHT 20/

20

CORR. TO 20/

LEFT 20/

•...

CORR. TO 20/***•

C.

STANDING

(3 тіть.)

SYS.

DIAS.

60.

BY 72.25

BY $2.25

REFRACTION

s. - 0,175

"s.= 0, 25

By len

cx 180

cx 16 S

NEAR VISION

2ÃO CORR. TO 30

200

corR. To

BY sams

BY same

62. HETEROPHORIA (Specify distance)

ES°

EX°

R. H.

L'M.

PRISM DIV.

12

PC

PD

63.

RIGHT E

ACCOMMODATION

LEFT

66. FIELD OF VISION

Nurinal

70.

• HEARING

RIGHT WV •

''His. st

*/15

54, COLOR VISION (Test weed and res

VTSICU"

asses

57. NIGHT VISIÓN (Test used arid score)

NIBE

.71.1

Риванок

-250

500

1000

2000

PRISALCONV:

Tentho

65. DEPTH PERCEPTION

(Test used and ecore). "."

68. RED LENS TEST

Aa1s751909

3000

1000

8000

-000

UNCORRECTED

CORRECTED, - *

69. INTRAOCULAR TENSION

72. PSYCHOLOGICAL AND PSYCHOMOTOR

(Teals used and score)

73. NOTES (Continued) AND SIGNIFICANT OR INTERVAL HISTORY

woin glasses 3 years NINS

High. Frequency hearing boss Al s

11010

165.50/

4.2%

74, SUMMARY. OF DEFECTS. AND'DIAGNÖSES (Lial diagnoses wich item number»):

EXÁMINEE DENIES FAMILY

OF

DIABETES/FSYCHOSIS

HX

USE

OF

HY

CONTACT

OF

LENSES/DR..GS.

MOTION

DISTURBANCES

SICKNESSI

CONSCIOUS

LIHER STORTET-

71. hich frequency hearing loss All SEVERE

attent.

75, RECOMMENDATIONS-FURTHER SPECIALIST EXAMINATIONS IMDICATED (Specify)

76,

r0:2"

77. EXAMINEE (Check)

A. DO IS QUALIFIED FOR

(S)

B. IS NOT QUALIFIED FOR

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

Marcel elide

Sate me vein

I: TYPED OR PRINTED NAME OF AMÍSICAN EXAMINER

* TYPED'OR PRINTED NAME OF PHYSICIAN

4EN: PRIDE

8Í. TYPED OR PRINTED NAME OF DENTIST OR PHYSIC

•MAJ. USAE NIC

(Indicate which)

SIGNATUI

SIGN

LATURE

8Z. TYPED OR PRINTED NAME OF REVIEWING OFFICER OR APPROVING AUTHORITY

SIGNATURE:

A. PHYSICAL PROFILE

7H560,

B. PHYSICAL CATEGORY

NUMBER OF AT.

TACHED SHEETS

#GPO: 1971446-044/15

DocId: 32285210

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