◆ SpookStack

Standar PEOMULOATED, BURzAU Or.THE BUDGE REPORT OF MEDICAL EXAMINATION CIECULAR A-2 ST.NAME-FIRSTNAME-MIDDLE NAME 2.GRADE AND COMPONENT. OR POSTION 3.-IDENTIFICATION NO. EVANS,-Courtney Allen F.B.I. 4HOME ADDRESS (Numbret r RFDciy r townzone and Stale 5.PURPOSE OF EXAMINATIOY 534-Fishermans Road, Norfolk, Va. 6.DATE OF EXAMINATION Annual Physical: 3-2053 7.SEX 8.RACE 9.TOTALYRS.GOVT.SERVICE 10.DEPARTMENT.AGENCY.OR SERVICE 1.ORGANIZATION UNIT Male Cauc. MIITARY 1.CIVILAN F.B.I. 12.DATEOF BIRTH 13.PLACEOF BIRTH 14.NAMERELATIONSHIP.AND ADDRESS OF NEXT OF KIN 11-12-14 Missouri (w) Betty Evans, Same as # 4- 15.EXANININGFACILITY OR EXAMINER. AND ADDRESS 16.OTHER INFORMATION USNH,.Portsmouth, Virginia 17.RATING OR SPECIALTY LAST SIXMONTHS CLINICAL.EVALUATION NOTE Doscribo cvery abnormality in dotail. Enterportinent itom number boforo each sasy. not evaluated 18.HEADFACENECKAND SCALP A 19.NOSE A 20.SINUSES 21.MOUTH AND THROAT 4 22.EARS-GENERAL #23.*- Both drums scarred (previous otitis media). 23.DRUMS Perforation Intact. A c.n A 25. OPHTHALMOSCOPIC 26. PUPILs(Equality and reaction) 27OCULAR MOTY A 28.LUNGS AND CHEST (IncIude treasts) #28. Expiration, 35n; Inspiration, 38". A 29.HARTTerhythmnds A 30.VASCULAR SYSTEM (VaricOsitkes, etc. 31.ABDOMENAND VISCERA (IncIUde hernia) #32.. Pilonidal fistula reddened and crusted: No 32ANUS AND RETUM A 33.ENDOCRINE SYSTEM drainage. A 34.G-U SYSTEM A 35.UPPEREXTREMTIES >th,rangee A 36.FEET 37.LOWER EXTREMTSZ A 33.SPINE.OTHER MUSCULOSKELETAL A 39.IDENTIFYING BODY MARKS.SCARS.TATTOOS 39 Moles, lower epigastric region and right 40.SKINLYMPHATICS upper quadrant of abdomsn A 41.NEUROLOGC A 42.PSyHATRC Spynyprydeition Fomalosonly Chick howo done 43.PELVICVAGINAL RECTAL Continuo in itom73) 44DErAL (Place oppropriate ymbols abore or eloro number.f upper and touer tethrepectiely) REMARKS AND ADDMONAL DENTAL DEFECTS AND O-Restorable teets X-Missing tets 68Fized bridgebrackes to 1Nonrestorableteeds Replaced by dentures include abutments x 3 4 5 6 8 10 11 13. 15. 30 29 28 27 26 23 22 20, 19 1 31 2 24 21 LABORATORY FINDINGS 45.URINALYSIS:SP.GR. 1.014 46.CHES xRAY (Place date fum number. reul) 47.SEROLOGY (Speify test sed and resu SUGAR USNH,. Perts, MICROSCOPIC Va3-2053 Neg. F1m-#4722: Negative Neg.- Neg 48.EKG 49.BLOQQ IYPE AND.PH ComMOT ve 60 segs. 1966 38 27 MAR 24 1ymphs. 2eos 67 -StRECADED 27 yA 24 %9 - 15* 02 y-7-s3.vC