NMS Form Y
(1939)
REPORT OF PHYSICAL EXAMINATION
Purpose of this examination: [illegible] ANSWER TO REGULAR NAVY & PER.
Date of examination: 28 August 1945
Place of duty: NASD, PHILA., PA.
Place of examination: NASD, PHILA., PA.
Name: NEWHOUSE, Delbert Clement 177283
(Surname first, Christian names in full)
Rank: Lt. (jg)
Corps: USN
Place of birth: Oregon
Date of birth: 6-5-13
Family history: Irrelevant
History of illness or injury: Mumps, Influenza, Measles, Fracture of left clavical and scapula, Appendectomy 1930.
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Head and face — Normal
Eyes: Pupils (size, shape, reaction to light and distance, etc.)
Round, equal, react to L & A
Distant vision Rt. 18/20, corrected to 20/20 by Lenses
Lt. 18/20, corrected to 20/20 by Lenses
Binocular vision — (Without lenses—Recorded only when visual defects exist)
Color perception — Normal AOP 1940
(State edition of Stilling’s plates used)
Disease or anatomical defects — None
Ears: Hearing
Rt. Watch 40/40" Coin click 20/20' Whispered voice 15/15' Spoken voice 15/15'
Lt. Watch 40/40" Coin click 20/20' Whispered voice 15/15' Spoken voice 15/15'
Binaural — /15'. Disease or defects — None
(Spoken voice)
Nose — Normal
(Disease or anatomical defect, obstruction, etc. State degree)
Sinuses — Normal
Tongue, palate, pharynx, larynx, tonsils — Normal
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Teeth and gums (disease or anatomical defect): Normal
Missing teeth: #17, 32
(List numbers)
Nonvital teeth: No. 9
(List numbers)
Periapical disease: None
(Degree)
Marked malocclusion: No
(Yes or no)
Lack of serviceable occlusion: No
(Yes or no)
Pyorrhea alveolaris: None
(Degree)
Teeth replaced by bridges: None
(List numbers)
Meets dental requirements: Yes
(Yes or no)
Dentures: None
(Description)
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Mark missing teeth by X whether replaced or not. Show size and position of caries in black, use red to indicate fillings and restorations.
[Diagram of upper and lower teeth with markings:
Upper row: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Lower row: 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32
Red marks indicate fillings/restorations; X marks missing teeth at 17 and 32.]
Signature: M. NOVSEPIAN, (DC) LT. USNR
(Signature of dental examiner)
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General build and appearance — Medium
(State whether slender, medium, or heavy, and postural abnormalities)
Temperature: 98.6
Chest at expiration: 39
Height: 73"
Chest at inspiration: 43
Weight: 198
Circumference of abdomen at umbilicus: 35
Recent gain or loss, amount and cause: None
Skin, hair, and glands: Normal
Neck (abnormalities, thyroid gland, trachea, larynx): Normal
Spine and extremities (bones, joints, muscles, feet): Normal
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16—11249