MEASUREMENTS AHO OTHER FINDINGS
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$3. COLOA waln

G4. CoLon EVES

268. BuiLo.

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CD avancer ( wcowe
$7.

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a
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ins

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(8 wn)

OUETANT Vision

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Bb. AFTER BXEACIRE
.

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QEFRACTION

C. 8 Gin. AFTER

©

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63.

ACCOMMODATION

aant

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64. . coro vision

O98. FeDEPTH
sal PERCEPTION
er}

67. wien vision (Test weed and scors)

6B. MED Lens TesT

}

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ital

CORRECTED

66. FIELD OF WisiON
70.

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AUBIOM@ETER

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1900
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9048

GS. INTRAOCULeR TENSION

T2. PEYCHOLOGICAL AND PSYCHOMOTOR

(Tests weed ond score)

ao00
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ao00
4000

sooo
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Sef

atent

Len

|

73, notss (Conanuad) any Side/FICaNT O8 UNTERVAL MIBTORY

Using beta-ganma survey meter MI-5, background reading .03 -.06 mr/br. No radicactive
contemination found.

(Uee additional setts Uf weceasnry)
Ja. SUmMaARY OF BTFECTS ant O1ewonts (List diagmesss with tiem numbers)

7S, SECOMMENDATIONS—FURTHEN SPECIALINY ExauinaTions mmolcaTeo (Specn/y)

76,

A. PHYSICAL PROFILE

®

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h

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e

a

77. cnawiner (Check)
a. 6 16 ovarieigo ron

G. PHYBICAL CaTeeony

sb. Os wor quacirino For

70. 10 NOT QUALIFIED, BIST CISQUALIFYING DEFECTE BY [Taal mubeca

a

79. TYPED OF PRINTED MAME OF PHYSICIAN

SrOmaTURE

00. Trego OR PAINTEC WAME OF PHYSiCran

siamatuRe

81. TYPED OF PRINTED MAME OF DENTIST OM PHYBICIAN Uindhonts which)

BISNATURE

O2. TYPED OR PRINTED NAME OF AEVIEWING OFFICER OR APPROVING KUTHORITY

SreMATUAL

CARL L, HANSEN, Lt Col,USAP,MOWS

e

¢

£

NUMBER OF AT=
TACWED BHELTS
CB. GOVERNMENT FRINTNE OFFICE,

BEST AVAILABLE COPY

1087 D—~ehese

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