POSTMISSION PHYSICAL EXAMINATION
Document Type:
Collection:
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
Case Number:
Publication Date:
June 20, 1967
Content Type:
FORM
File:
Attachment | Size |
---|---|
![]() | 20.51 MB |
Body:
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
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Declassified in Part -Sanitized Copy Approved for Release 2013/06/12 :CIA-RDP69B000418000200040001-2
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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
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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
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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
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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
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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
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Declassified in Part -Sanitized Copy Approved for Release 2013/06/12 :CIA-RDP69B000418000200040001-2
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Declassified in Part -Sanitized Copy Approved for Release 2013/06/12 :CIA-RDP69B000418000200040001-2
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