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DISPOSITION FORM
PRIVACY ACT MATERIAL
For use of this form, see AR 340-15, the preponent ogency is TAGCEN.
REFERENCEOR OFFICE SYMBOL
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SUBLECT
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Results of Medical Examination
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FROM
(Joint Task Group
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C, Physical Exam Section? ATE
,TAMC APO SF
Results of medical examination for
(Name)
a.
Physical Profile:
b.
Physical Category (Alphabetical Code)
c.
Age
qd.
Height
e.
Weight MAA® Pounds.
f.
Glasses
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Date of most recent periodic medical examination Gk: ae
h.
Immunizations up to date
i.
Date eye examination completed
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Normal complete blood count with differential
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Individual is/iswret fit for Enewetak duty.
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SF? Ue
WILLIAM F. RUSCHHAUPT, III, M.D.
MAJOR, MC
Chief, Physical Exam Section
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PRIVACY ACT MATERIAL REMOVED
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