This form would later become the ubiquitous Army Form B.178 and would go through many design iterations. A prime example of its usefulness to the military historian can be seen in the image below which lists all the stations where this particular soldier was examined or received treatment.
The front of this form also gives a lot of useful and interesting personal detail about the man, detail that would not make its way onto Army Form B.178. This particular form was begun in 1866 and as can be seen from the reverse, the man re-engaged in 1878.
Images are Crown Copyright, The National Archives.