This is a useful four-page document which not only gives crucial information about a soldier's age, regiment and enlistment date, but also gives us an insight into how Medical Boards arrived at their decisions on whether or not to make an award.
Page 1 (above) gives details of the soldier and a statement of the case dictated by the man but recorded by the Medical Officer in charge of the case.
The answers to these questions continued onto page 2.
Page 3 is where the Medical Board records its opinion.
This assessment carries over to page four. Arguably the most important part of this form is question 24 which assesses the level of disability.
All document images reproduced on this post are Crown Copyright, The National Archives. Service and Pension records can be searched and downloaded from Ancestry and Findmypast. Both companies offer FREE 14-day trials.