MEASUREMENTS ANO OTHER FINDINGS
61. anew
$2. woent
83. COLOR HAIR
$4. coLoe Eves
68. sumo.
66, Temrenatune
D surssee Co eeoiee
$7.
BLooe parseuRc (Aru at heart Level)
a,
srrtine
se.
ora, 122
a.
v8.
oecer
ouas.
atcus-
ous, 90
se.
c.
sd.
(3 man)
cas.
eTancing
GISTANT Vision
Ol weave
0 once
eucee (dpm af Asart iesal)
aw StrTiné
O. AFTER BKERCICE
C. £ MIN. AFTER
B, RECUMBENT
E. AFTER STANOING
a wre,
“
60.
PErkaction
a1.
wtak vision
ment 207
come, FO 70/
w
a.
ox
corn. To
a
LEF? s0/
ComA. TO 20/
w
s
ox
comer. To
er
$2. netreopwonu (Speniy distance)
cet
63.
a*
me,
ACCOMMODATION
on
Oust bry.
Past Conv.
4
>
@4. cotton vision (Tew weed and resud)
4s. pets prgcermion
06. FIELO OF vision
67, NieKT vision (Test weed wad seera)
68, REO Ltue Test
76.
TI.
aieuT
alent wv
tery ey
)
umcoaaecren
uzrr
conaceres
WEARING
#10 ov
nese
/18
fs
aUBIONETER
re
soo
aif
1f00
1005
2400
S068
63, irtasccuLaa TEasion
7a. Fereeey AWD PETCHOMOCTOR
sooe
sage
soce
sace
S144
ence
G88
Rian
Lert
73. mores (Confinusd) ame stenFICANT O8 INTERVAL HISTORY
In 3-PD raditations .l~.5 m/e, not above background.
(Use eddienel sheds i{ necenary)
74, SUMMARY OF DEFECTS ane Gladeotee (Liat diagnose WA am members)
75. RECOMNENOATIONS—FUATHEA SPECIALIST EXAMINATIONS INDICATED (Specify)
76.
a. PHYSICAL PROFILE
uy
Ls
«
*
s
77. cxamingg (Chest)
& O19 ouauviee roe
». Ch ee wor uauiricn roe
B. PUTSICAL CATEGORY
78, 1) MOT QUALIFIED, LIST DISQUALIFVING DEFECTS BY ITSM NUNDER
a
78, TYPES Of PRINTED HAME OF PHYSICIAN
BienaTuae
06, Trete on PRINTEO NAME OF PuTEICIAN
sieuaTURE
1, Trees on vanree SAGE OF DEWTIET Oa PuYelctam (imainate whiah)
creaaruag
G2. TYPED Om PRINTED NAME OF REVIEWING GPHICER O8 APPROVING AUTHORITY
sienatuag
CARL Le HANSEN, Lt Col,USAFMO,7S
e
e
e
.
MuUMhER OF AT.
TACHED SUCETS
UB SOVERNNENT PhIETING GeTleE. ERP G—208885
BEST Avan