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[[preprinted form]] 
CHANGE IN FLYING STATUS FOR MEDICAL REASONS [[/preprinted]] 
DATE ^[[9 August 1956]]
TO: ^[[Commander, 13th ATF (Prov) Taiwan APO 63]]
FROM: ^[[Office of the Flight Surgeon MAAG Dispensary Taiwan APO 63]]

I. IDENTIFICATION DATA
LAST NAME, FIRST NAME, MIDDLE INITIAL
^[[DAVIS, Benjamin O. Jr.]]
GRADE ^[[Brig Gen]]  SERVICE NO ^[[1206A]]
RATING, DESIGNATION OR FLYING DUTY
^[[Sr Pilot]]
ORGANIZATION ^[[13th ATF (Prov) Taiwan APO 63]]
TOTAL FLYING TIME ^[blank line] AGE ^[[44]]

II. ACTION RECOMMENDED ^[[See Remarks]]
   |SUSPENSION FROM FLYING STATUS IN ACCORDANCE WITH PROCEDURES OUTLINED IN CAPTER 10, AFM 30-3, AND OTHER APPLICABLE DIRECTIVES. 
[[X]]|REMOVAL OF SUSPENSION FROM FLYING IN ACCORDANCE WITH PROCEDURES OUTLINED IN CHAPTER 10, AFM 30-3, AND OTHER APPLICABLE DIRECTIVES.
   |EXCUSAL OF SUSPENSION FROM FLYING REQUIREMENTS BECAUSE OF AN AVIATION ACCIDENT IN ACCORDANCE WITH THE PROVISIONS OF THE AFM 160-1 AND AFM 173-20.
   |PERMISSION TO PARTICIPATE IN FLYING ACTIVITIES FOLLOWING AN AVIATION ACCIDENT OR EXCUSAL THEREFOR. (Not applicable if excusal has exceeded three months.)

III. FLYING STATUS
DATE FOUND PHYSICALLY DISQUALIFIED (Day, month, year) ^[[3 Aug 56]]
ESTIMATED DURATION OF PHYSICAL (Days and months) ^[[Less than fourteen days]] DISQUALIFICATION (Days and months) ^[[Four (4) weeks]]
SERIOUS ILLNESS (AFM 160-1)
[] YES  [x] NO
DISQUALIFIED RESULT OF AVIATION ACCIDENT
[] YES  [X] NO
SF 88 ATTACHED  [] YES  [X] NO
DATE FOUND PHYSICALLY QUALIFIED ^[[8 Aug 56]]
ACTUAL DURATION OF DISQUALIFICATION NOW BEING REMOVED (Days and months) ^[[Five (5) days]]
LAST MONTH FLIGHT REQUIREMENTS MET
^[blank line]
ACTION REQUIRED BY HIGHER HEADQUARTERS
^[[None]]

IV. INDIVIDUAL PRESENTLY SUSPENCED BY
AERO ORDER [blank line]
HEADQUARTERS [blank line]
PARAGRAPH NO. [blank line]
DATE [blank line]
EFFECTIVE DATE OF SUSPENSION [blank line]

V. SUSPENSION CONFIRMED BY
AERO ORDER NO. [blank line]
HEADQUARTERS [blank line]
PARAGRAPH NO. [blank line]
DATE [blank line]
DIAGNOSIS (AFR 160-13) ^[[(4260 Bronchopneumonia, organism und.)]]
REMARKS ^[[Request two copies of Aero Orders be forwarded to FSO]]

TYPED OR PRINTED NAME OF FLIGHT SURGEON OR MEDICAL OFFICER ^[[Robert N Helton, Captain, USAF, (MC) AME]]
SIGNATURE ^[[Robert N Helton]]]]

AF FORM 1042 15 DEC 53
* U.S. GOVERNMENT PRINTING OFFICE: 1954-283080
[/preprinted]]