ott. ite Pca Ee rae Eo eel fmm eet ee ee eee ee % ADWMSION BOTES Aeris Me Sux il. 1720 hes Cy! Dis @. RELIGION RATING OF DESIG. ~~ 1B. WAME AND ADDRESSEE - aes 2 ere “UNICAL RECORD COVER SHEET 3. TYPE OF CASE 2 on ne ened ee = ei ne ree 2. WARD S. ot ae MAY MAME —— FIST RAM — BIDDLE INITIAL C tm . mta _ PREV. aDaM@. 8, Chr fel x 12. SDDEE2S DEPARTMENT OF t 13. RESISTER uO. 8. 24499 SEnVicZE NO. 19, 14. GRGAMIZATION AND BRANCH OF SERVICE AEC Breach, Las Vegas S EMERGENCY O) 1@. AGE 17. BACT a Cau 20. 18. LENGTH OF SERVICE GRADE Lt. FLYING STATUS 19. DATE OF ADMISSION 3 yes 15 Sep 58 SOURCE OF ADMISSION Frem Duty ey eee tan HnterSyae Starus tor AF Military Personnel only. show type (Dep. of EM, etc.) io space 13. ADMITTING OFFICER NT 21. puewoszs (Mac) TOUry. okie ercuy, Nevada He AUSTDISMITH, CAPT compm (See tnstructions for recording of shown on reverse side. 1. 6919 — Dg Inctude all Furwncle, n.e.c. multiple Arms & Body. [De For > ytic staphylococcus Yes PRIVACYACT MATERIAL REMOVED 24. OPERATIONS AND SPECIAL THERAPEUTIC PhoceDUEES (Show date for each: shaw anarthetic for each operation) SELZCTED ADMINISTRATIVE DATA (Show mature of and daies for board proceedings; show fect of and dates for leave, AWOL, mbeisting elsewhere, detached service. ¢ic.) , oa: Me . a6. ; TYRE PREvious J £ es Te +; Laie SO ~g + ot ft ¥ ‘re Ee iw Sit ~~. mRIAL bral H : PHYSICAL PROFILE x s rR T SUFFIX D ° N CO ra. PROFILE (5 ONCHANGED REVISED 27. DAYS BURATION THIS FACILITY LEAVE atr—_A__ ts HOSPITAL O8 INFIRMARY—.-__@_____suasistine ELSEWEERE___.._____-QUARTERS OR DISPENSARY. WATURE OF DISPOSITION 30. 32. ; Li Of) SIGMATURE OF ATTENDING PHYSICIAN meaty 3/2 W MILLS, CAPT UsaF (WNC) MAME AMD LOCATION OF MEDICAL TREATHERT FACILITY oe 1956-407 134 CATE OF DLSPOSITION LLh eae alTak Soiled Por an el ae Mise Nevaea wor ~~ Féerte Tis Aixs USAF Hospital, Replaces DD 481 (4 part set) which may be used. DD it's: 481-3 4S20th tz U. S$. GOVERNMENT PRINTING OFFICE OTHER. 29, 23, | ERLGISTER NUMBER eae »