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GRGAMIZATION AND BRANCH OF SERVICE
AEC Breach, Las Vegas
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EMERGENCY
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1@. AGE
17. BACT
a
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20.
18. LENGTH OF SERVICE
GRADE
Lt.
FLYING STATUS
19. DATE OF ADMISSION
3 yes
15 Sep 58
SOURCE OF ADMISSION
Frem Duty
ey eee
tan
HnterSyae Starus tor AF Military Personnel only.
show type (Dep. of EM, etc.) io space 13.
ADMITTING OFFICER
NT
21.
puewoszs
(Mac)
TOUry.
okie
ercuy, Nevada
He
AUSTDISMITH, CAPT compm
(See tnstructions for recording of
shown on reverse side.
1.
6919
—
Dg
Inctude all
Furwncle, n.e.c. multiple
Arms & Body.
[De
For
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ytic staphylococcus
Yes
PRIVACYACT MATERIAL REMOVED
24. OPERATIONS AND SPECIAL THERAPEUTIC PhoceDUEES (Show date for each: shaw anarthetic for each operation)
SELZCTED ADMINISTRATIVE DATA (Show mature of and daies for board proceedings; show fect of and dates for leave, AWOL, mbeisting elsewhere, detached service. ¢ic.)
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PROFILE (5
ONCHANGED
REVISED
27.
DAYS BURATION THIS FACILITY
LEAVE
atr—_A__ ts HOSPITAL O8 INFIRMARY—.-__@_____suasistine ELSEWEERE___.._____-QUARTERS OR DISPENSARY.
WATURE OF DISPOSITION
30.
32.
; Li
Of)
SIGMATURE OF ATTENDING PHYSICIAN
meaty
3/2 W MILLS, CAPT UsaF (WNC)
MAME AMD LOCATION OF MEDICAL TREATHERT FACILITY
oe
1956-407 134
CATE OF DLSPOSITION
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Féerte
Tis Aixs
USAF Hospital,
Replaces DD 481 (4 part set) which may be used.
DD it's: 481-3
4S20th
tz U. S$. GOVERNMENT PRINTING OFFICE
OTHER.
29,
23,
|
ERLGISTER NUMBER
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»