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Standard Form 88
(Rev. Aug. 1950)
PROMULGATED BY
BUREAU OF THE BUDGET
CIRCULAR A-24
jmh REPORT OF MEDICAL EXAMINATION S-3
1. LAST NAME—FIRST NAME—MIDDLE NAME
2. GRADE AND COMPONENT OR POSITION
3. IDENTIFICATION NO.
NEWHOUSE, Delbert Clement
CHPHOTOGRAPHER
177283/8311
4. HOME ADDRESS (Number, street or RFD, city or town, zone and State)
5. PURPOSE OF EXAMINATION
6. DATE OF EXAMINATION
3581 S.E. Grant Ct., Portland, Oregon
Promotion
7-12-55
7. SEX
8. RACE
9. TOTAL YRS. GOVT. SERVICE
10. DEPARTMENT, AGENCY, OR SERVICE
11. ORGANIZATION UNIT
Male
Cauc
MILITARY 22-06
CIVILIAN
USNAVY
VU-5, USPACFLTAF, FPO, S.F., CALIF.
12. DATE OF BIRTH
13. PLACE OF BIRTH
14. NAME, RELATIONSHIP, AND ADDRESS OF NEXT OF KIN
5Jun13
Marcola, Oregon
(W) Norma I. NEWHOUSE/Same as #4
15. EXAMINING FACILITY OR EXAMINER, AND ADDRESS
16. OTHER INFORMATION
USNAS, NAVY 3835, FPO, S.F., CALIF.
Rel: P
17. RATING OR SPECIALTY
CLINICAL EVALUATION
NORMAL
ABNORMAL
(Check each item in appropriate column; enter “N.E.” if not evaluated)
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 61)
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 78)
X
42. PSYCHIATRIC (Specify any personality deviation)
Females only
(Check how done)
43. PELVIC ☐ VAGINAL ☐ RECTAL
TIME IN THIS CAPACITY: TOTAL
LAST SIX MONTHS
NOTES.—Describe every abnormality in detail. (Enter pertinent item number before each comment; continue in item 73 and use additional sheets if necessary.)
#39. ANT: 3S½" Frontal; S½" Lt.Eyebrow; S½" Above Upper Lip; LS1" Rt.Thumb; OPS RLQ 3"; SS Lt.Knee; S1" LU Tibia
POST: LS1½" Infrascapular, Lt.; S½" Lt. Thumb; LS1" Rt.Hand
(Continue in item 73)
44. DENTAL (Place appropriate symbols above or below number of upper and lower teeth, respectively)
O.—Restorable teeth
X.—Missing teeth
(6 × 8).—Fixed bridge, brackets to include abutments
I.—Nonrestorable teeth
XXX.—Replaced by dentures
R I G H T
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
17
X