Standard Form 88
(Rev. June 1956)
REPORT OF MEDICAL EXAMINATION
1. LAST NAME—FIRST NAME—MIDDLE NAME
NEWHOUSE; Delbert Clement
2. GRADE AND COMPONENT OR POSITION
CHPHOT (W-4) USN
3. IDENTIFICATION NO.
177283
4. ADDRESS (Number, street, city or town, zone and State)
7 Mrs. Vencel Richter
P.O. Box 127 Garibaldi Oregon
5. PURPOSE OF EXAMINATION
Pre Retirement
RELEASE TO
INACTIVE DUTY
6. DATE OF EXAMINATION
12-18-59
7. SEX
MALE
8. RACE
CAUCASIAN
9. TOTAL YEARS GOVERNMENT SERVICE
MILITARY 11.3 CIVILIAN
10. AGENCY
U.S. NAVY
11. ORGANIZATION, UNIT
U.S. NAVAL STATION, SAN DIEGO, CALIF.
12. DATE OF BIRTH
5 June 1913
13. PLACE OF BIRTH
Oregon
14. NAME, RELATIONSHIP, AND ADDRESS OF NEXT OF KIN
Norma I. NEWHOUSE(W) 652 Burham St. El Cajon, California
15. EXAMINING FACILITY OR EXAMINER, AND ADDRESS
U.S. NAVAL STATION, SAN DIEGO, CALIF.
16. OTHER INFORMATION
RELIGION: Protestant
17. RATING OR SPECIALTY
TIME IN THIS CAPACITY (Total)
LAST SIX MONTHS
CLINICAL EVALUATION
NOR-MAL
(Check each item in appropriate column; enter “NE” if not evaluated.)
ABNOR-MAL
X
18. HEAD, FACE, NECK, AND SCALP
X
19. NOSE
X
20. SINUSES
X
21. MOUTH AND THROAT
X
22. EARS—GENERAL (Int. & ext. canals) (Auditory acuity under items 70 and 71)
X
23. DRUMS (Perforation)
X
24. EYES—GENERAL (Visual acuity and refraction under items 69, 60 and 67)
X
25. OPHTHALMOSCOPIC
X
26. PUPILS (Equality and reaction)
X
27. OCULAR MOTILITY (Associated parallel movements, nystagmus)
X
28. LUNGS AND CHEST (Include breasts)
X
29. HEART (Thrust, size, rhythm, sounds)
X
30. VASCULAR SYSTEM (Varicosities, etc.)
X
31. ABDOMEN AND VISCERA (Include hernia)
X
32. ANUS AND RECTUM (Hemorrhoids, fistulae) (Prostate, if indicated)
X
33. ENDOCRINE SYSTEM
X
34. G-U SYSTEM
X
35. UPPER EXTREMITIES (Strength, range of motion)
X
36. FEET
X
37. LOWER EXTREMITIES (Except feet) (Strength, range of motion)
X
38. SPINE, OTHER MUSCULOSKELETAL
X
39. IDENTIFYING BODY MARKS, SCARS, TATTOOS
X
40. SKIN, LYMPHATICS
X
41. NEUROLOGIC (Equilibrium tests under item 72)
X
42. PSYCHIATRIC (Specify any personality deviation)
43. PELVIC (Females only) (Check how done)
□ VAGINAL □ RECTAL
NOTES. (Describe every abnormality in detail. Enter pertinent item number before each comment. Continue in item 73 and use additional sheets if necessary.)
Ant. scar (3)½" frontal, S½" lt eyebrow, S½2 above upper lip LS½" rt. thumb, OPS RLQ 3"
(Continue in item 73)
44. DENTAL (Place appropriate symbols above or below number of upper and lower teeth, respectively.)
- O—Restorable teeth
- I—Nonrestorable teeth
- X—Missing teeth
- XXX—Replaced by dentures
- (6 X 8)—Fixed bridge, brackets to include abutments
R I G H T
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
L E F T
X
32
31
30
29
28
27
26
25
24
23
22
21
(20)
19
18
X
REMARKS AND ADDITIONAL DENTAL DEFECTS AND DISEASES
CLASS 1
LABORATORY FINDINGS
45. URINALYSIS: A. SPECIFIC GRAVITY NORMAL
46. CHEST X-RAY (Place, date, film number and result)
U.S. NAVAL STATION, SDIEGO, CALIF.
70MM CHEST FILM. NO. 38367 NEG.
B. ALBUMIN
NEGATIVE
D. MICROSCOPIC
50. OTHER TESTS
NONE EKG NORMAL 12-18-59
C. SUGAR
NEGATIVE
47. SEROLOGY (Specify test used and result)
PRESUMPTIVE KAHN
NEGATIVE
48. EKG
NOT DONE
49. BLOOD TYPE AND RH FACTOR
NOT DONE
Finished File B62
APPROVED SECNAV 19 FEB 1960