MENTS AMO OTHER FiNDImOsS Ot. masent 82. wrient $7. BB. COLON HAIR 84. covonk Eves BLooe patesuar (drm of heart lena) a artes 4.728 vias, be. & evs, ater elas. atcus- FO] C) ecenoen () weoius OC) weave se. e. ove. (8 ensa.) Bias. OTAMDING DISTANT WIsIOW OB, SuILD, B46. Taertaaruar eucer Cinm of henri ional) & GITTine 0, © oonee OB. APTER Gaencite REFRACTION ¢. 8 Gin. Aree S. RECUMBENT 61. © AFFER BTANDING 8 om. eran vigwea isnt 20/ conan. to a0/ or 5. oz. conan. to Cd Vert no core. TO B0/ oy s on coma. to oy 62. neteaoPHoas (Specify dustenes) us? oe aan in PRISM Biv. PRitu Conv. < Lad er es. AccoUMODATION meet 68. oR prere wg eaacertion rey @7. siext vision (Test used and amore) 68. ATO Les Test , | vucownecras conauctas OS. FIELD OF Vision 70. tat 4, cOLon vision ( Ten weed end covull) urt HEARING 7h. geuT wr sin sv it oer wy fv av 18 AUDIOMETER 30 B66 poo 618 ra00 £004 s000 8068 OS. rrvmaccucan TEmsion 72. Creer eeea Ane sercuouoraa sooo 8856 ao00 M008 econ Olas soos 8198 QlienT Leet 73. morte (Combaned) and SIGNIFICANT OF IMTEAYAL MIETORY - ‘In = 39PD Raditations ele. mr/hr, not above backgrowld (Use additional aheds (/ secssary) 74. Quamany OF DEFECTS AND SiscuosEs (Lan deagneess wih Hen numbert) 78. RECOMMENDATIOND—FUNTHER BPECIALIST ELAMINATIONS InOIcATED (Specify) 76. a. PHYSICAL PROMLT Pp L M £ 5 77, craminge (Check) & 0) is quatirien ron o. Oye wot auativies ror ®. PHYSICAL CaTESORY 78. IF MOT QUALIFIED, LIST DISQUALIFVING DEFECTS SY ITEM NUMBER a 7%. TYPED OA PRINTED BANE OF PrYeiciAn SIGMATUAL OO. TYPED OR PAlmTED NAME OF PuYeiciAN Siematuar 1. TYPED OR PRINTED WAME OF DENTIST OR PHYSICIAN Limdicate whack) SIGNATURE 82. TYPED OR SIGNATURE CARL L. HANSEN, bt Col,USAF,MO,7S PRINTED MAME OF REVIEWING OFFICER OR APPROVING AUTHORITY e c t NUMBER OF AT+ TACHEO SWEETS 4, . GOVERNMENT PRINTING OFFICE: LOET O—askane BESTAVAILABLE COPY