POSTMISSION PHYSICAL EXAMINATION

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP69B00041R000200040001-2
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 304
• Document Creation Date: December 27, 2016
• Document Release Date: June 12, 2013
• Sequence Number: 1
• Publication Date: June 20, 1967
• Content Type: FORM

STAT
Declassified in Part -Sanitized Copy Approved for Release 2013/06/12 :CIA-RDP69B000418000200040001-2
Declassified in Part -Sanitized Copy Approved for Release 2013/06/12 :CIA-RDP69B000418000200040001-2
 r
Declassified in Part -Sanitized Copy Approved for Release 2013/06/12 :CIA-RDP69B000418000200040001-2
,~;~; . .
,oa3x:
POSTMI.ISION `~YSICAL EXAMINATION
1
NAME
STAT
MISSION DATAt T/0 Dat? ~ a ~UNr ~ ~?
.
T/0 Time
Landing 5 L
-
Duration .~": 34
Mission Number ~~~ ~
2:
DATE ~~ :)UN~ G~ TIME L~ ~~
3.
j
EKAMINATIONs ~~ `
O
~
WEIGHT
~
RESP ~~ B/P
C
PULSE
TEMP
,_
_
-~s--
a. HEENT ~ j--
b. CARDIOVASCULAR ~ ~R
c. RESPIRATORY
d. GENERAL
PSYCHOLOGICAL EVALUATION
DURATION IN SUIT ~~~~~??
LIFE SUPPORT PROBLEMS _ ~,/ ~~?_,.,
6. SUIdMARY AND FLIGHT SURGEON ~ S COMME~PPS
Atch 4 to ANNEX E to
----------OPLAN
STAT `~
Declassified in Part -Sanitized Copy Approved for Release 2013/06/12 :CIA-RDP69B000418000200040001-2
 Declassified in Part -Sanitized Copy Approved for Release 2013/06/12 :CIA-RDP69B000418000200040001-2
PRE~IISSICN PHYSICAL EXAMINATION
1. NA'ME~ ~~lISSION DATAt T/O Date '2,D ~t~lt/L~I?
,_
Primary ~ Secondary B/v Expected Duration ~b7,~ Q~
~ MiOaion Nuanber
Z. DATA ~ ~ N +L TIME H- Z? ~ O O
RECENT HISTORY AND FAMILY HISTCRYt ~O` ~~ :,
SUBJECTS COMPLAINTS:~~~
~~',G1
EXAi~INATICN t WEIGHT~~ ,TEMP,PU SE,RF~P~,B/P Z~
9. PRESUITIN4 PHYSICAL CHECKt Time H- ~ ~ Yy
?_
b. CARDIOVABCULAA~
,S~
a. HEENT ~.~C'~' Y~
_
a. RE3PIAATORY 1~~.'L
COMMENTS CF FLIGH`F SURGEON ON ITEA,S 3-6 s
...
V 1 s
REPORT. TO MZ38ION COORDI TOR s ate ~ i~ ~ ~p 7 Time +y 2- ~'S L.
Pilot Statue ~ '' H- L~ ~, d
Temp ~~~, Pelee ~ ,Reap
ADDITIONAL GOMB2AVT8.BY FLIGHT SURG$ONe
STAT
Declassified in Part -Sanitized Copy Approved for Release 2013/06/12 :CIA-RDP69B000418000200040001-2
 "' oaax oa3x oaa
`IH%
~-?_
Declassified in Part -Sanitized Copy Approved for Release 2013/06/12 :CIA-RDP69B00041 8000200040001-2
Primary 9eoondarq ~ B/U
NAME
RECE[~IT HISTORY AND FAMILY HISTORY t ~ O
Eacpeated Duration ,~~;Q,O
Miaeipn Number ~' ~70~,..
2. DATPS 1-t ~V/V~i+p7 TIME H- ~~+.,
SUBJECTS COMPI,AINT9: Ly ~,~.~?
~,. ?
REVIEW Ot' SY9TEM8 t
,. RTe'Q'PTRARYIAY ee below)
/ 9 ~~~~ 196_
Requeai; your attendance at the Commander~a Briefing to be held i.n the
Operati.ona .Briefing Room on ~~ ~~~~ _196 at ~~ ,~~~~ L. The
briefing concerns the follrn+ing:
Date/Time of Launch (H Hour}
Ground Spare (H~l:AO): 20
J
~.~'~~
z/
i/~o z.
.~
5 ? . Ha:~ea s Takeoff C~ ~ ~, Staging , Landin~~A ~ ~ 1.1 A
Equipment required: ~ 1r t7f ~. ,~..,.,? ~ ~t P,y. ~,~~_~a.y ~' !? ~~ _
Office Time L Recipient
DCOC/MC ~ ~4a -~+~J'.
DCOMI
DCOW
COMNiO
8. Spacial Tnstructiona/C~~ . ~.~ts: ftia '' !^l ~~'~C.~ ~A ~ ITT ~ ~~U ~+?
7. Ground Spare .Requireme:it n s ~ ~F Y4'~'~ ~-~ ~ r ~ , w ~~-Y'Q:..
Declassified in Part -Sanitized Copy Approved for Release 2013/06/12 :CIA-RDP69B000418000200040001-2
 Declassified in Part -Sanitized Copy Approved for Release 2013/06/12 :CIA-RDP69B000418000200040001-2
- ..
., :.,,~,~; .: ,.~,~,~,?~,~-,:~, .~.,~; it"n is ny~ n ic'HiC~('i~ n'n K~Yi~iYi>oG-T
.
-1 :00
Rec R-2 7 Tanker Wx Data
B-9
-.-,
(ylY~, PRr/G,rt~ ~/}rXl
J
~ ~!~
~ l~
2 ~.
L / 1'~i' ~
~`c
-1 0
to . TTFC
B-9
.
/~ZD
20 4/20
(~ DS
~
~1
-10:00
Send R-2 6C
B-
?
-9:00
Rec Rb2 Msn Wx Data
-11
.I
r 20
G9Z2Zt
~ 1 3 `~-~
- : OO
Give R-86 I~' ut to htsn Card
-2
~ ~`~ ~
~ Z 2 ~
f~ G~ ''
I S L
r
-8:00
Send R-2L~1(If reguiee -16
~Y
S2Q
0320
Q~~?~'r~h~c~-
~'y
~-I3
x635
D~y~ +.
~
.
-5
JY
Z z zo
072o
-
b_7 p l y
___
7/_.
Declassified in Part -Sanitized Copy Approved for Release 2013/06/12 :CIA-RDP69B000418000200040001-2
 Declassified in Part -Sanitized Copy Approved for Release 2013/06/12 :CIA-RDP69B000418000200040001-2
pOti3%I
WEATHER DEBR I EF I IJG FORM
1 GOP~PLETE BEFORE DEBRIEFING-:
ART I GLE ~ IZ PILOT ~,=i ~'?~' ~1l' DEER I EF I fJG
TAKE OFF TI ME /f/~--L UB,~~~ '? ~ ~fRT ~~'~~ WIND Z lC~ PA +`33C?
LAl\ID I NG T I ti1E_%~ L UB 7c=~-~{'~??~.^~ TYD VJ I NU -,? f? ~--1~~'
50X1
T I~ME f 7?~ L DATE '~,
FL IGHT~f nX670S ROUTE 13S `~tg 1rJEA BRIEFED BY
2. GUMiPLETE llUR I NG DEBR I EF I IrG
MISSIUN WAS(SUC;t;ESSFUL)(UfvSUU~ESSFULllUE TO_
MAX MAUH .IS MAX ALT ~ZM! T thr-E ABV ,50PJi Zf45 MAX
TURBULENCE DETAILS: ,
N'f ENSI TY ALTITUDES LOC:AT I UN
,~
U I T ~ by AT ~ ~. lA
ABC; SPLELi FiLAD I r,~G ATT { T
A~;TUAL ~u11EA 4VAS E3SENT I nLLY aS BR I E~FED EXGEPT~? ~,~ L,~~~x- :~
~c~~ ~S'~~R~~
Declassified in Part -Sanitized Copy Approved for Release 2013/06/12 :CIA-RDP69B000418000200040001-2
 U 1~ ~ , ~ ~"~ r~r,nrntrM1TTl1hT ~ in" V'L1:+CriJi I I` Vl'Lt~VHUt
Declassified in Part -Sanitized Copy Approved for Release 2013/06/12 :CIA-RDP69B000418000200040001-2
 N~r+,~
31
Declassified in Part -Sanitized Copy Approved for Release 2013/06/12 :CIA-RDP69B000418000200040001-2
O~SERVATIOI~T a ~' OBS~aRVATIGN ~ ~- ~b"T ~ ~' ~ ` '~'~ p
1 y t ?~~ C ?~ J
.fin mF~/rr, , ~' ! ~~
~2~7zS~1 ~aS zt~4
T~i-oY~li~i G ~
~ISi~-t,~J 17~
hA~r~ ; 73~
rA~/
~ 2 QD cD~ /0 z~a6
2
~~
ram ~ ~ z. ,~ r~
2s~ ~~a z ~ ~,'
ZdCG ~"i1C 'z37,~ ~~~i ~%c:~ ~ s
$m ~ rip ~~ 7
;~!/ z
~Q~zl~~iT~7 ~~~
m ~~ ~ ~~~~
vT~i
-Q~E' CAfIt~ ..yt~'~.ir..TL
vS!? --__ __ - ~
N~?~- V 1l~tS
Ooh
hf~4 Vr6~
:~,,rp,~T ~~TUi~
u-~.~~G ~ ~rBv
~IA~~"~
v!3 v ~Y
11~L~U
~rU:-~
^~I.fNu -
h~l vTc~
___
2~?iaoCU~~o?/~-zo 23~o z~cf r,~~~~7~;c~+/~p~a zzc:y
zAmY3o~ Qu/Z ZS7~ 7 ~cc=5' /rL? 7 ~5~~f ~ ,. j~-~m? 1 ~ ~ 2
(2GColcm7 1 G,~ /b c~ ~l ~-CL1 ? 17c~ L ! ~ l ~
;; tC SC ,
~, I c~-viz. zzp~ 1-c~ 2s ~.m -cm zs I ~
"`'
~ ~-rC?7 G ALyn ! ZLC' 7 C. t~. rti
~t~Ul / c.,4c, ~
l2C~i(-CLC 7 CALwI /CL7 GALm /Ctp7 G~~y~ 7.v-tGlr~(~1 ~~1 71C(~~ CQ1 C:
i ~~ ~
~, ..
fi shim/sties/~ ZuG 5ac~~lc?7 r~~ 7 . ,~:clst~~lc~ Zsu< ?+cx~zac,QSOc?17acID1~? zom~orl~~~r~/LD7 zo~~
r , T 3z~t~acc~ l
;~
n~~ G~ w 0 ~ u9 33c'7 cr3 Se-~ /~U12o z~03
G~.~ zv 3 ~- 3ta ~ C~'~ ~o . ~ Gt~~ ~ ~ ~ ~ 3 .
'y ~C~ ~c fire w c B s ~. ~ c.R k s ~-1->z. ~ 320 ~ c~ ~ ~y CL.~. ~." 305" rc ~ >
~ B Se s ~ _
ox Sta rotor lC?e~ ~i4~n~ 3oCp t~~'1'~. ,zoc+9 3a !t?v u l 8 / ~ uz c `~~ S Z 1 cA~ 3otpjzam~u~ 8 ~~6.3
~ A I C1~ j ~~t~(c~e c~~,~ . ~ ZrQ7/ ~? m
i ~ tZt ~ .