ielehetiatpanat , teen enitamyinrctantitistoat wifes CLINICAL RECORD COVER SHEET % ADMISSION ZOTES 2. Warp 3 @ sex! Aor Ns xe u 3. TYPE OF CASE i pis 6, RELIGION o Kone 13. NAME AND ADDARSSEE 2 Wa BASY Ramet — FIRST RARE —— BIDOLE GITIAL C) ac : 7. PREV. ADM. 8, REGISTER XO. (2. 13. OBGANIZATION SND BRANCH OF SERYICE js Qe U. GATING O8 DESIE. 1615 hrs / k md DEPARTMENT OF | 9. SERVICE NO. 24740 AUEISPHS: ADORESS 10. @MADEZ 14, Lt Col FLYING STATUS nb Public Health Service EMERGENCT (@. AGE 17. RACE 44 tw) 18. LENGTH OF SERVICE 0 19. DATE OF ADMISSION 3 yrs 18 Oct 38 20. SOURCE OF ADMISSION From Dety Nots: Enter flying Status for AF Mili Personnel only, Civilians, etc., show type (Dep. af EM,ee.) in space 13, 21, piece 9611 ADMITTING OFFICER UR) 22. CONTINUATION OF ITEMS 13 AND Zo. LOMRIS M BOWERS, CAPT USAF 23. DIAGNOSES (See instructiony for recording as thewn on reverse rid. Dg 1. 8501 Camp Mercury, Nev. Include all required relateddata) Concussion of brain, mild. AI: For LDe Yes Semetime during the morning of 18 Oct 58, Camp Mercury, Nevada,patient fell froma “runway”, Fur«her ae ay aye details are wakneown. Wes performing assigned duties as Sanitary Engineer, was net on a military reservation. w ~- | ? 24. OPERATIONS AND SPECUL THEWAPEOTIC PaoceDtts Lkow date’fer cack; show atesthaths for etch operttions™ «.« oa ] . - tee Te “ 2 sae - Tap Crem Ta taeele on . rr Sof Geb ae: : IT yy Te ya aur rr . ~ - nae 4 25. SELECTED ADMINISTRATIVE DAT (Show nature of and dates for board proceedings; show fact of and dates for leave, AWOL, mabsisting elsewhere, detached service, etc PRIVACY ACT MATERIAL REMOVED 26. . PHYSICAL PROFILE SERIAL TYPE P ¥ L SUFFIX H Ez s R T D o N PROFILE Is UNCHANGED PREVIOUS REVISED 27. DAYS CURATION THIS FACILITY AU 26. -F HOSPITAL OR INFIRMARY-——_______-3-_SURSISTING ELSEWHER E———_—__—___QUARTERS OISPENSARY. SIGNATURE OF ATTENDING PHYSICIAN /s/XHM WOMILLS, CAPT UsaP (NC) CLES , 32, MAME AND LOCATION OF MEDICAL TREATMENTFACILITY — 1 SEP s2 481-3 wy U. §. GOVERNMENT PRINTING OFFICE OTHER Replaces DD 481 (4 part set) which may be used. 1956-40714 _7 DATE OF DISPOSITION 21 Oct 36 R MEDICAL RACORDS OFFICER 33. a 420thUSAF Metpita DD LEAVE 28. Duty 39. OR NATURE OF DISPOSITION REGISTER NUMBER —2eMO-