Part 114, page 34

Transcript

The scan is the source; the transcript is machine-generated from it.

33. ABDOMEN AND VISCERA—N. S. A. [X] A. LIVER—N. S. A. [X] B. SPLEEN—N. S. A. [X] C. MASSES—NONE [X] [illegible handwritten entries]

34. HERNIA. (If present describe location, size, shape, reducibility) (Complete or Incomplete) NONE [X]

35. ANUS AND RECTUM—HEMORRHOIDS, FISTULAE, OTHER ABNORMALITIES N. S. A. [X] [illegible handwritten notes]

36. VENEREAL DISEASE NONE [X]

37. ENDOCRINE SYSTEM N. S. A. [X]

38. G-U SYSTEM N. S. A. [X] (Include prostate exam. If indicated) PELVIC—N. S. A. [] VAGINAL DONE [] OR RECTAL DONE [] [illegible handwritten entries]

39. SPINE AND EXTREMITIES—A. BONES—JOINTS—MUSCLES—N. S. A. [X] B. FEET—N. S. A. [X] [illegible handwritten entries] C. GAIT—N. S. A. [X]

40. NEUROPSYCHIATRIC—A. NEUROLOGICAL (Consider CRANIAL NERVES, MOTOR STATUS and COORDINATION, REFLEXES, SENSORY STATUS, EQUILIBRIUM. Always mention EXACT LOCATION.) B. PSYCHIATRIC AND PERSONALITY. (Consider BEHAVIOR, COMPREHENSION, COHERENCY OF RESPONSES, EMOTIONAL REACTIONS, ORIENTATION, MEMORY, and SIGNS OF TENSION.) [illegible handwritten entries] TEST USED SCORE A. NEUROLOGICAL—N. S. A. [X] B. PSYCHIATRIC—N. S. A. [X] C. PSYCHOLOGICAL TESTING TEST USED SCORE D. PERSONALITY DEVIATION YES [] NO [] (If answer is yes, explain and cite recommendations under Item No. 42)

41. LABORATORY TESTS—A. SEROLOGY (Specify test used—Result) KAHN NEG.

B. URINALYSIS ALBUMIN SUGAR HGCR DONE NEG NEG MICROSCOPIC NEG

C. BLOOD TYPE AND CLASSIFICATION USED [illegible]

D. OTHER LABORATORY EXAMINATIONS [illegible]

42. A. REMARKS—B. SUMMARY OF PERTINENT AND INTERVAL HISTORY—C. SUMMARY OF DEFECTS—D. DIAGNOSIS (Use additional sheets of plain paper of same size if necessary) [multiple lines of illegible handwritten text]

E. PHYSICAL PROFILE P U L H E S 1 1 1 1 1 1

PHYSICAL CATEGORY (Check) A [X] B C D E

REMARKS (If "Physical Category" is other than A, specify reasons for such classification) [illegible handwritten entries]

43. FURTHER SPECIALIST'S EXAMINATION INDICATED [] YES [X] NO. IF YES, SPECIFY EXAMINEE (IS) [illegible] (Strike out one) QUALIFIED FOR RELIEF FROM DUTY [illegible] E. TYPE OF QUALIFICATION IF NOT QUALIFIED, LIST DISQUALIFYING DEFECTS AND RECOMMENDATIONS [illegible handwritten entries]

44. SIGNATURE OF PHYSICIAN [signature] NAME TYPED OR PRINTED G.C. ELLIOTT CAPT. MC.

45. SIGNATURE OF PHYSICIAN [signature] NAME TYPED OR PRINTED W.C. BUSS 1ST LT MC.

46. SIGNATURE OF DENTIST, OR PHYSICIAN (Indicate which) [signature] NAME TYPED OR PRINTED W.J. BOLPAT CAPT. DC.

47. SIGNATURE OF REVIEWING OFFICER [signature] NAME TYPED OR PRINTED DATE [illegible]

★ U. S. GOVERNMENT PRINTING OFFICE: 1949 10—57709—1

DB Cooper-10656