PREMISSION PHYSICAL EXAMINATION

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP69B00041R001800010053-1
• Release Decision: RIPPUB
• Original Classification: S
• Document Page Count: 2
• Document Creation Date: December 12, 2016
• Document Release Date: June 14, 2002
• Sequence Number: 53
• Publication Date: March 8, 1968
• Content Type: REPORT

Approved For Release 200 (0 ( C .ml3 P69B00041 ROO1800010053-1
PRR,IISSION PHYSICAL EXAMINATION
25X1A
1. NAME
2. DATE 7 March 68
MISSION DATA: Date 8 March 68
Take Off Tim,.
Expected
Mipaion
3. RECENT HISTORY AND FAMILY HISTORY:
4. SUBJECTS COMPLAINTS:
REVIEW OF SYSTEMS :
TIME 1300 L
6. EXAMMINATION: `,EIGHT Tf 1P `2i / PULSE. -26 AESP figw- }3/P IS 2-
UEENT
a.
G. RESPIRATORY
7. LABORATORY WORK (If required)t HCT
3. COYMENTS Of FLIGHT SURGEON on ITENS 3 thru 7:
9. F'RESUITINO PHYSICAL CHECK: Time
,r@ ,P 1 g ", PULSE
1(
Atch 2 to ANNEX "F" to
'US fl R f> h;;-i
Approved For Release 2002/07/10 : CIA-RDP69B0d041 R001800010053-1
 Hpprovea ror rteiease zLpqpff~v t# r
25X1A 1. NAME f,ISSION DATA: Date- 8 March 68
ma'~C8 Of -f Time
Expected Duration
Mipeion Number BX 68r-
2. DATE 7 March 68 TIME 1300 L
4. SUBJECTS COMPLAINTS:
5, REVIEW OF SYSTE19:
6. EXAMINATION: WE;IGHT~
J
.__TEMY PULSE 2_RESFJ F I
~
,
a. HEENT '-,/y G'~''~i1%r.Cx--C
b. CARDIOVASCULAR -YV"
c. NESPIRATORY
URINE_ OTH ER
7 . LABORATORY WORK (If required) : HCT
COMMENTS OF FLIGHT SURGEON on I'TENS 3 thru 7:
9. FRE3UITING PHYSICAL CRECK: Time /'(7 S
T P PULSE `7 2-- L~ESP /# L#/P~_
10. ADDITIONAL COMMENTS BY FLIGHT SURGEON :
25X1A
FLIP ounkIPSON
Atch 2 to ANNEX "F" to
C,i S ORDER
Approved For Release 2b02/07/10 : CIA-RDP69600041 R001800010053-1