| KentSpatrea ad Ce erad Sorwes Aldineises abso teeagem y Counot een Liter. s toa € 4 Mel {hast NAME ay REPORT OF MEDICAL EXAMINATION Re word FIRST NAME ys PRIVACV.ACT MATERIAL REMOVED ae Reni Ste dina a m—, 7 an : MIDOLE NAME ‘(2, GRAOL AND COMPONENT OR POSITION | 2. IDENTIFICATION No 1 woe a ee gO ee & 4dL. Sed wee 4 HOME ACORESS (Number, ert or PED. cry orlown, Stoo an! ZEEE ale. = ‘ 7. "s PURPOSE! OF EXAMINATION Ea 1 __ oo. SEX fa RACE Tr _ Lt Ts. TOTAL SFAWICE iH { FXAMINING FACILITY OR [rou “ANO C6MMAYER TRIPLER CLIMICAL SOR Mal + { : bad :'X : ’ , . . umn eriter ONE T8 PAD FACE $9 NOSE 20 LIN. SEG approntiate ' 21 Men TH AND) THROAT bare, EN aE ' nf - wb eek tg ber pameate - i fe mma Wang + bes MOA Cra oo _ |! Enter pertinent trem number before aac (Deacesbhe every abnormaiity in detail - # ‘ TIME IM THIS CAPACITY ( Total) commen? 4 5 : ohne a rw eee LAST SEX MONTH, Continue anctem 7) aad use additional sheers sf om ovary j i ) d : + . - athena, cee tm vers wae POPS OF paddy aed reaetian Doe aR MT SEE rte Emirate Tatty mue: eee ue Ora Veda Me ge gnele 26 -~4 Wo . 2toort, | Maa | Woks 1/7 ANT, SCALP CO a NOTES = at orf rot ead.viatew NECK eo. es 2 mM Pertaratiaan, ae - EVALUATION Teer each Ttemin : Hl ~ . ion ese wate t 16. OTHER INFORM ATION AsAT . Ph 7 tt. ORGANIZATION umiT yj 4 tHST-GAM-PE ae ee 6 DATE OF CRAMINATION MY UDNA_ EWveClPIA Ronnc ck | 14. @AME RELATIONSHIP, ANG ADORESS OF NEXT OF KIM 7 17 RATING OR SPECIALTY r4 To 10. AGENCY we TRS S. yx a ac ERG UTA KK YEARS GOW! RNMENT +N Causiete LR, Benth oe OATE OF BIRTH ;1H. PLACE OF BIRTH . we ee eee ANE, CME GT om Ca te Cla digade teeaetae 29 HE ERT Shri, atee, rAgthca mnndss 10 A ULAR ST UTEM Chariconitien ef, ‘ 31 ABDOMEN AND VISCERA Cf nelide Aeratre Me aN 3) ENDOCRINE OYUTEM 1‘ ‘ . ily 40G 35 ‘ , ANC. a . Phe mmartNusds Tuk Jor sedate af ' afal te mes ated range of . * . 1 roth PPE REM TREMITIE Mteemgth Maem? W 3 . . } _ oo + : SKIN, LYMPHATICS a _ =: . ‘ P-Oere . + 21: = ’ VY . ! + NEURO OGIC tF ywrdshe sum teats ander tiem + 4 Yo / x Kft PSYCHIA TRIC iNpeetfpane prrannality deeiuatian ’ | 43 PELWC (Pemales only) (Check how done) | i CJvaciar [Jase tae | d ! 2 Kestoruble soit loath Neat ? j , t+ re stron ble R tot H tT we z° 2 9 Ry 45. URINALYSIS . B. ALBUMIN c SUGAR —---- — 3 30 4 §S A SPECIFIC GRAVITY —= : 6 28 ttn 6 naosner af apper and fawer tecth. } _— VDRL-NONREACTIVE , ; 48. taG ‘j 3 4 ( ; 2 ti-4 demures 0 24 tf 2B 2 8 22 ae r ee . 7 2t - woes yt | #9.) BLOOD TYRE ANT Kit | REMARKS ANO ADCITIONAL DENTAL _ ‘ Re io df : " © mid Mirvvom, leeth 8 | 9 a je MIPROSCOPIC + ® (Continue tn stem 73) At a? ee - - NEGA TF CA SY be 2 1 t woos 19 18 LARORATOSY FINDINGS NEGATIVE 47) SEROLOGY TSpeetfy feed waed an F 27 ” - pA . —r bts foeth a ' . ee gd A DC nd Car | 44. DENTAL (Phive appropriate swahals, shaun sn examples, whace ar below ] i ) , . | j 420 | : OTHER MUSCULOSRELETAL 39 IDENTIFYING BOOY MARKSCARS taTtoos| Al -~ a “FT OweRr Rem Pitre pt beet LOWFR EAT RE MITIES?ENtrenygth range uf mata 34 SPINE @ =~ FEFT — ; DEFECTS AND DISEASES fared a © Puretreal ' the atercs 7 x : . 0 E I { Ord S OF oT j ’ 46. CHEST X RAY (Pace, date, Alm number and reralf| ‘ NORMAL CHEST X-RAY TaAMC, Wg 6357 3O, “OTHER TESTS Fe fe2,7. FACTOA . . % \ PRIVACY AC VED T MATERIAL REMO ;