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MEASUREMENTS AND-OTHERFINDINGS 51.HEIGH GT 067.Bron 53.COLOR HAIR 54COLOR EYES Gray 98.4 57.BLOOD PRESSURECAmdteartlece 58.PULSE (Arm gt heartle Sys. 104 SYS.100 RECUM- Sys. 108 SITTING AFTER EXERCISE SITTING STANDING BENT 3min 84 3MIN. SYIa 70 DIAS. 70 DIAS. 76 104 84 80 84 59. DISTANT VISION REFRACTION 61. NEAR'VISION RIGHT 20/202 C BY. S. CX J#1 CORR.TO 8 LEFT 20/20 CORR.TO20/ BY S. Cx J CORR.TO BY 62.HETEROPHORIA: ESo EX RH. L h. PRISM DIV. PRISM CONV. PC PD 63. ACCOMMODATION 64.COLOR VISION Test used and resut 65.DEPTH PERCEPTION UNCORRECTED Test used and score RIGHT XLEFT .0.1940 Rey-Horma CORRECTED 66. FIELD OF VISION 67.NIGHT VISIONT ud and e 63.RED LENS 69.INTRAOCULAR TENSION X 70. HEARING 71. AUDIQMETER, 72.PSYCHOLOGICALAND PSYCHOMOTORTes Ued andcOre) 35880 0120o /15 RIGHT70 LEFT WV 75 155 55 /15 LEFT 0:0. 73.NOTES CORinUedAND SIGNIFICANT OR INTERVAL HISTORY Childhood illnesses: Measles,:mumps, scarlet.fever,chicken pox. T & A-age 9. Roming ears,several episodes. Adult illnesses:. Otitis media, bilateral,. 6 years ago. Pilonidal cyst, drainage yearly, since 1940.. Last infection was 4 months ago. Use additional sheets of plain paper f necessary 74.SUMMARY CF DEFECTS AND DIAGNOSES Lt diagno th em numers #23. Scarred tympanic-drums: Hearing good: NCD.. #32 Pilonidal fistula reddened and crusted:. No. drainage now. NCD.. 75.RECOMMENDATIONS-FURTHER SPECIALIST EXAMINATIONS INDICATED (SpCciSy) 76. PHYSICAL PROFILE None 7.EXAMINEECk IS Strenuous exertion QUALIFIED FOR PHYSICALCATEGORY ISNOT 78. 1F NOT QUALIFIED, LIST DISQUALIFYING DEFECTS BY ITEM NUMEER B C E SIGNATUR C.L.FERGUSONCAPTAIN.MC)USH 0.TYPED OR PRINTED NAME OF PHYSICIAN SIGNATUR B.A, JOHNSON.. CDR(NCUSN SIGNATURE G.R.COURAGESI (DC USN 2TYPED OR PRINTED NANE OF REVIEWING OFFICER OR APPROVING AUTHORITY SIGNATURE NUMBER OF AT- U.S.COYENXENTPRINIXGCFICE 16-62283-1