| REFERENCE OR OFFICE SYMBOL 7 wmoe @ proponent? agency |s TAGCEN. : SUBJECT ; Commander FROM (Joint Task Group C, Physical Exam ‘Section"= TAMC APO SF Enewetak) Results of medical examination for _. Pnoysical Profile: P | (Name) U L E | | 2 YI © / 2- PRIVACYACT MATERIAL REMOVED In. Weight >. Classes =. Dete of mest recent periodic medical examination of | = immunizetions up to date o!/ O Pounds. Yes No. + ae , | | | 2 pa — Ft > / V1 S . Height 4a ~ . fe Age E ! i . (SSN) ec. Physicel Catezory (Alphebetical Code) c. CHT 96438 (Rank) @. 4034632 Results of Medical Examination EST-PE Te ——! WoSem obs For use of this form, 300 AR 340-] | j : . . UY Yes . ij Se ce 7 ft | No. Date eye exexination completed lf Sve 77 — J. Normal complete blood count with differential k. Individual =s¥is not fit for Enewetak duty. Mor Pure FIED. 2 * Yes No. pho FSi ®. esc OF, (oe WILLIAM F. RUSCHHAUPT, III, M.D. ” MAJOR, MC Chief, Physical Exam Section gt- bace pe Bette bn Klatt tteerts _— 99 suwtTI- fe DA. KELAEMEY | ; PRIVACY ACT MATERIAL REMOVED mA Fore DA tFEB $2 2496 REPLACES DD FORM 96, WHICH IS OBSOLETE. _ ~ - is we nee wee ULS. GLPLO, 197F- SAT OTS |