MEASUREMENTS AND OTHER FINDINGS $1. nelent 02. weiewt 03. Coron main G4. COLON EYEE 68. euro, 68. Tearaaaruee OC atsmose 0 wevive 67. bLoop Patesuec (Arm af Aaurt imal) a. arrtine orm oe s se. e Bicum. 4 ect Dias. bras AS os. 778. evn. eyvanDine (3 wan.) BLTTANT Vision | Oras. éo. Cowan £ oscet eure (Aru of heart lead) & SITTING B. AFTER ERERCION WEFRACTION C. & MN. AFTER ©. SECUMDENT #1. &. AFTER BTANDING BMI, SCAR vision mienT 207 cone to 20/ w a. or cone. to oy LEFT 20/ CORA TO 80/ ar 5. ox come to ey 82. nevcnomionia (Spen/y dhatonce) as° ae 63. on ACCOMMODATION wopaT! nieur La Paige BIy. Paine Cony. e < Ga. OLOR vision (Test weed and reoull) O65. Chas preva eerenrtion ey 67. sient vision (Teal weed and ecors) $0, QED Lees TET ) | vacornecteo Ltr conacette 66, FIELO OF ViBION 76 . 0 ? 1. MEARING fiewt wv fia sv fue Lert wy f18 8 ae AUDIOMETEA 880 956 soo Sif 1800 308s tage 0048 OS. itsaccucan ‘TENsio8 72. fess PETCHOLOSIOAL pie AND PEYCHO ; MOTOR acca Bane sone sac0 6145 ange Sree wie? ire i 72. woTes (Commmuad) ano BIGHIFICANT OR IITTERYAL HieTORY In 39 PD radations: .l-.5 mr/ir, not above background (Uses additional sheds Uf necessary) 74. SumMARY OF DEFECTS and Diagnoses (Last dragnoees with vam members) JS. MECOMMENDATIONS—-FURTHER SPECIALIST EXAMINATIONS amDICATEO (Specify) 78. & P PHYSICAL PROFILE u L # t s 77, examince (Check) & G is quativien ror ». 1 us wor quauirigs ror ®. PuYBICAL CATEGORY TB. Of WOT QUALIFIED, LIST DIBOUALIFVING DEFECTS BY ITEM HUMBER a 78. TYPED O8 PRINTED HABE OF PHYSICIAN " SIGMATURE 80. TYPED Of PRINTED MAME OF PHYSICIAN SienaTuRe O1. TYPED ON PRINTED HAME OF DENTIST OF SUTSICIAK (Znchomls which) srenatuae @2 TYPED OR PRINTED NAME OF REVIEWING OFFICER Of APPROVING AUTHORITY SIGNATURE CARL L. HANSEN, Lt ® c c ColL,USAF MC, a} NUMBER OF atTACMED SWETTS B, DOVERMMENT FALTING OFFICE: 1907? O—aasaen os: BEST AVAILABLE CO PY