Medical report on a 16 year-old Iraqi male detainee shot in the head. The medical records do not state how the detainee received his injuries and does not give any personal information on the detainee.
AUTROF112131 FOR LOCAL REPRODUCTION
'MEDICAL RECORD PROGRESS NOTES
DATE )r..e.f..4....c......",..,...7 .."?-,..4 4,-..r. /erica-a-G..1 214rw NOTES
W21107 l/- a Pi 1 4,_&.,,.,4,A- 6.SDI •Ze• *7-v-i-, -
/ U' 3o ,es72 -1-'rt1 At.14-e_ 4 04e.14,44,0 ,-71.004-4.--Caz17f
- .
,,...0-6,z,,,&z.: &;y1E) ..re.,.4 0....-64,-.4, a,...,ii,j,...„.„./.7).--,,....., rept.e...,
Azim alai 6
ar:4111111,We) -CL- 1/4 Fes,) (6) 2-/a&5 #4,0,-.:14-1 , a•St-r 441 /•.1-4-,,c_visa,zee iCe
esA,..-;- //3 el.' S.:, Aii4.eb..,,_44 V24.1 i6 w-kii,, 7)-,14,,, Aele Vette, eaftaile-,---n beer (Sy sleet., Zt-pc LI ..i-v-, fst:;,,
714.41 ( L 7 A fe,e /4;,-- re-zir: le
kx.a.: • 0
1,...L4-4/1.0,44-4-...442 - ' „f,..ert.to -oz.-14--5re /41,13 v_v• • slii....
LOCO —
.
RELATIONSHIP TO SPONSOR
SPONSOR'S NAME SPONSOR'S ID NUMBER LAST FIRST AM or Me) •
IN
DEPART.ISERVICE
HOSPITAL OR MEDICAL FACILITY RECORDS MAINTAINED AT
PATIENT'S IDENTIFICATION: Flo typed or mtroi mina. Die: lime "44 fray iih"• RESISTER NO. WARD NO. ID Now S$11; Set; Dan of Mt6' liudaiidel
PROGRESS NOTES Medical Record
STANDARD FORM 509 (RR. 511999)
Prescribed by SSASCIAR FPAIR MICRO 101.11.203114110i
USAPA nor)
MEDCOM - 20041
DOD-033615
AWITIDRIZED FOR LOCAL REPRODUCTION
.
PROGRESS NOTES'MEDICAL RECORD
NOTES
DATE
P-4..%) 1 c P rs itaAkt—jatfivt__ tt,Lt 2-imeize-d cti"ci ti,KA 1 -114,1- 7—g4.--1-s-ri 4-4t/;144.
,1
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d AiN LI 11" L . A ,Plr...,—, c Pnr.1 -4 c2;.1 irvie-1
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r
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rA
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214.0\,,LNA,_.
t M A A :L/•-¦
SPONSORS ID NUMBERRELATIONSHIP TO SPONSOR SPONSOR'S NAME
OM Oder/ •
MI
FIRST
LAST RECORDS MAINTAINED ATHOSPITAL OR MEDICAL FACILITYDEPARTJSERVICE REGISTER NO. WARD NO.
PATIENT'S IDENTIFICATION (for typed e nriftell look iir: New-lest firM ID No or MN; Sex; Diu of Bilk Rank/Wel
PROGRESS NOTES Medical Record
STANDARD FORM 509 IREV. 5119991 Prescribed by GSAOCMR FPMR MICFRI 101-112D3DAIDI
11111mo
Ee L0
USAPA Vi .00
MEDCOM - 20042
DOD-033616
LAST NAMt FIRST NAME. I MIDDLE INiTIAL ID NUMBER
DATE NOTES
ia-eku
5-
ci&
gli1V A . ka 4 A 4' ; 1_
_./41 A
IN A
,„17. LAI' • • 04,,1 .
' )c
02—f.Mos m
. St 1 A AI. dt%•
142,0 S - I
al /9s-o. 4 cc/
an--ek (Js:ac. 710 .h/Lco_kt&o:"
a.314,„: a al--r-e ettti
..,••••¦••O'
I, At ALa t
130 r SD S . I CP Laid lz Ja-v-4 n %/1
STANDARD FORM 509 MEV. 511999IBACX
USAPAVISIO
MEDCOM - 20043
DOD-033617
LAST NAPA FIRST NAME MIDDLE INITIAL ID NUMBER
DATE NOTES
a5S" - i 4 1_4/e,/ ./F2--,.r, -l5 Y k 10,27 l 1 ' 4-11.•\_e_ Ve4'•' 1 . • i 2' 0 e ¦. La% # 700 /7 3 i. . -1(-1.-Z-/57/f; Aie r-4/ -tom. IA i --A An-— ?,..,,, f ).1-14,41 64 po. 15 ,,4,(..9,__i c).-/4te c-f )--diAc_s2_ as, , _s--0(-4-y-o •
Z-• Jz-'-'4eii• -5i/FFQJ' .1\jc. d)r ' 1-\ aL IA -Ari --Q.,,o,,,,...,-„--ii--„e6e,,,,.),„: . „...,,,, 6.pid ('-J L. / / VS' iPz.vkr,ltr-r z4re. c,/-" 1 -Q--___......„.,.t..,;,, Je ‘ ,
STANDARD FORM 509 miv. sting) BACK
MEDCOM - 20044
USN% VIM
DOD-033618
AUTHORIZED FOR LOCAL moDurnom
NEDICAL RECORD PROGRESS NOTES
DATE NOTES
A A /Id
-
r-71 .1% r s. A 1 24 (fill•.',,--. S'.1,. ,2::CP AT— - —
/ qz.
0-,A, 7; ‘i-- P ' to -yx- A (.-4.,14,_ :'/IT,. 14,z /
14:, 6:/-1 6-rpt
,...._ - c.
(.0,2,, 44s . /---4 c 1-,-or //2/1&4' , iik Iv\ ;el i',-)f), e^1-. ICY1 S— — grlkr
),,L,TI,,,a 1,,c.f.,fc_ ce:uw_i clitios-),, s
.4 k,-_,J prQ Y3i,i' 7:---€71-er 46.,,I, t ._2?P /s-,,,,e2,-6' fX)-/ ))61-,6,7-0,,,fs/ ;),-,.., ,,, 3-— cza.jr 1: c-,1--c,N. -(-.,....(7ek, _,. -.e,c-,----r_c;-1.31,),.
47-reg,. )1'‘ 7-ha pxk/I7L .46/A cy?-d
c mare CZT 1 71 r
13en'er-s• —44);/
RELATIONSHIP TO SPONSOR
SPONSOR'S NAME SPONSOR'S ID NIARIER FIRST
iSSIYaretkr/
DEPARTJSERYICE
HOSPITAL OR MEDICAL FACILITY RECORDS MAINTAINED AT
FATIEINT'S WEWTIFICATIOR Mt/ typed of *Witte mks, gire: &Pr kst wak REGISTER NO.
WARD NO.
. WM; or SR Se c Dote of Rin Ibmk/Gialie
PROGRESS NOTES
gfr,i vim A)-‘1 Medical Record
STANDARD FORM 509 IREY. 5110991
Pre:wiled by GSMICMR FPNR141CFRI 101:11203fM110
USAPA VI.00
MEDCOM - 20045
DOD-033619
LAST NAME FIRST NAME. 1 MIDDLE INITIAL ID NUMBER
DATE 1°1/4147 Di c! j '-.w,-7,..,,... -....., it./1-6" IL/1' o -- /A t,.44-50, w.......r-•vt:,.. -e-i el-4--7 -/.7 ez-,y 4i4.44 .., .0 , P , / 0 . '/, i f , ---7-.--," /- 4 .4.4 ...ie oz-f----, ....----.c4.4.4 _Yte.e--_z_:-/---/ , it—6...r.,..._ _ Ace Ga-64-f-/ -6L.f _A-:.-, ,i..i-i, ii rir /4.,.%."f /et, 44_ /4-3._ _ //) pz-z -14,,, a i-,fg ,41, /1.s.--) Pi 0 1 "'1,--.--i, i
azper63 01.1-i.S E SO e,ivrisvf-,5,s7 -7,4„ )00 ,Z-1 4._lnievv!vii4.4 kyrRilic.14, . J:cfe 7-11 arc 96r-0/1`t i vp„.1f,,, ie'3012i Pit c-/ 7•18"- pt. K — el ---..4 9-3 1 Z7 Ccs 3i (1 ;--
(ie./IA-Ia. I .
• Oct., i c,e_sz 1,4 1.---Q , 41. Ak,44&LX-&X)CkrLItz . ' L) /4-.'rt. . & tei,t.,),,r l X7,6c.: ,--e--e Zo.t-ti4"le,-) le 1-(F, wit-c7te 1-_,.--1--e cif,q-,1,-e C.41z. L t., L i\rautworo /4-,_p ifwv, 11 i,4,, ,,e__ V.-,-1(_-_,p,r0 ._
CSX(t) 1-
STANDARD FORM 509 IREY. 5119993 13 USAP
MEDCOM - 20046
DOD-033620
MITROBIZED FOR LOCAL REPRODUCTION
' MEDICAL RECORD PROGRESS NOTES
DATE 0; 6c.r.--/-Cht. ' -. e 0,5 oqi- \„ V..7 --
qo s.'r iR iCo--11 vib NOTES -• Tap 170, qo cr 61 3 I oFF .fvzssti.s. i._.1'/;-',-..20
30.3 p, 0 -v2 ,rl 6A/Wt. 1 S--1 / - I . 4v. eiptf.r:-. -r,,pI t/R
.4 611.;-. -0 . flx.-. eAr-i(4 ('.1.-) /4,,,,,x ,s,10-ed 0
. 4,c-.rqr;t4,41.te,12/,0 pf-,,,,,.-4 ,),, ov,9 c.),„,,(/ (i.-,,,,, et v ,,._ 4 it /I', Ib -
(\)) ( () ---?
SPONSOR'S ID NUMBER /MN saga) • RELATIONSHIP TO SPONSOR SPONSORS NAME
LAST FIRST MI
DEPARTJSERVICE HOSPITAL OR MEDICAL FACILITY RECORDS MAINTAINED AT
041 .
PATIENTS IDENTIFICATIDAh (For typed or mint stir; girt: fitiat • last first raidtfic REGISTER ND. WARD NO.
• II1 ris or SSPI; 3a:fitted Birth: fiatilfiradt)
PROGRESS NOTES Nietical Record
STANDARD FORM 509 (REV. 5f998) Plumbed by GSADCLIR FPMR NICER) 101.112030A101
USAPA V1.00
MEDCOM - 20047
DOD-033621
AUTHORIZED FOR LOCAL REPRODUCTION
MEDICAL RECORD PROGRESS NOTES DATE NOTES
CR-r-03
40jAkkjea
OR 2-m% ie-e_ 2sx cted-ger's
t .1.1 Os 1 ,bto t Ed (
Cit'it-td s tuictAti --43,cci 0-ao u cca
ARATIONSHF TO SPONSOR SPONSOR'S NAME SPONSOR'S ID NUMBER
FIRST MI =orDead •
PIPARTJSUNICE HOSPITAL OR MEDICAL FACILM' RECORDS MAINTAINED AT
PATIENTS MENTIFICATION: ffor *prior mitten NON, pin: Nome • last net ma• W Nes v SSk Sec Dote of Br* Asa/Gude) rREDISTER NO. WARD ND.
PROGRESS NOTES
vw mar (vo Medical Record STANDARD FORM 509 IREV. 5/19981 Pusteribed by GSAIICAIR FPMR MICFN 101-11.203(bINCI USAPA
MEDCOM - 20048
DOD-033622
FIRST NAME.
I MIDDLE IMEAL.ID NUMBER
•
qb-Ir OUCAS4. CoL, rs,t V'
C t.-411;4) . crLikvs.
-1,k;mt
M,6) e.Yrioutl 654/
czo ra3
Aki,,(ez,r(eft
31' k% ? re3105-:A0 e_-'(-4 /1,N. e4, 0
-77/4-ry (Q4c4-:\i cr)
.€1171-.
00)((1-65(-0/1% -euTvp,„:1 e4-zre-7A h:E/71;11111111111 1 1S-17.1\/-:4)
" gZ
13-M.'s-krar.
STANDARD FORM 509 IREV. moo BACK
MEDCOM - 20049
USAPA V1.1:10
DOD-033623
LAST NAME DATE I I FIRST NAME NOTES IMIDDLEINITIALIII NUMBER
ato,z, ckso co*MPr‘ 7.CrAti•LtA-cCtrg' r\\+ -419-4 C.Ct-4/4' 4\6-1111111-cv4ka •
.T1 '4
Ir's \F" -4 •Cc‘424( "1-)NatzA CACC41),--r ov. ev-¦ c, tis-&fly\( \Nsilap-727A), hoe— r)S--CA.AerNi C°6,4) (-1°X6)17 /72/
- P%¦.A,12_A!—L-eaS •.Pi&. • ...rt.,/ /
MEDCOM - 20050 STANDARD FORM 509 can. snessi BACK
USAPA VI.
DOD-033624
NSN 7540-01-075-3786
EMERGEN CY CARE LOG NUMBER TREATMENT FACILITY
MEDICAL RECORD AND TREATMENT
(Patient) RECORDS MAINTAINED AT
PATIENT'S HOME ADDRESS OR DUTY STATION ARRIVAL
STREET ADDRESS F. f R I liall C)) (t/H c;. DATE (Day, Month, Year) 0 47 0 3 TIME .6-; 0 .2._ .
CITY STATE ZIP CODE TRANSPO TATION TO FACILITY
g
SEX DUTY/LOCAL PHONE MILITARY STATUS THIRD PARTY INSURANCE
rk AREA CODE NUMBER ITEM YES NO N/A ITEM YES NO
AGE HOME PHONE PRP FLYING STATUS ADDITIONAL INSURANCE DID 2568 IN CHART t
? AREA CODE NUMBER MEDICAL HISTORY OBTAINED FROM NAME OF INSURANCE COMPANY
CURRENT MEDICATIONS INJURY OR OCCUPATIONAL ILLNESS EMERGENCY ROOM VISIT
WHEN (Date) DATE LAST. VISIT 24 HOUR RETURNITEM YES NO
(---ne n YES n NO IS THIS AN INJURY?
WHERE
TETANUS ALLERGIES INJURY/SAFETY FORMS
DATE LAST SHOT COMPLETED INTITIAL HOW
SERB YES • NO .--7
3 PLAINT
CATEGORY OF TREATMENT VITAL SIGNS
TIME TIME a el. 3 0 a 0-, 1 i-
RGENT BP
1 IQ 71q:2---// VYc PULSE
7 INITIALS RESP / (a
in URGENT 9
/‹. TEMP
/94
1111 NO RGENT WT
I LAB ORDERS
CBC IFF . -r BHCG/URINE/BLOOD/QUANT
URI E C&S UA C/CATH / CHEM: /2_ Er ( I,
BLOOD C&S X ) -L
T ...1 , S-os-cik
X-RAY
ORDERS
;..7 CXR PA & LAT/PORTABLE C-SPINE
ACUTE ABDOMEN LS SPINE
SINUS
ANKLE R/L
I
ORDERS
(PULSE OX
MONITOR '
c.--TIME ORDERS BY COMPLETED BY TIME =II=
rye- -ESPONSE
C2.3 WlltrealllWnllIll1.11. 454: em
w
Mi7111 111¦ 50222 MENNIZEIMMIF
ra .1 .
Mlill
DISPOSITION DISPOSITION QUARTERS /OFF DUTY PATIENT/DISCHARGE INSTRUCTIONS
n HOME 11 FULL DUTY n 24 HRS. n 48 HRS. n 78 HRS.
MODIFIED DUTY UNTIL RETURN TO DUTY
CONDITION UPON RELEASE ADMIT TO UNIT/SERVICE
TO WHEN
REFERRED
I MPROVED • UNCHANGED
DETERIORATE TIME OF RELEASE I have received and understand these instructions
PATIENT'S SIGNATURE
PATIENTS IDENTIFICATION (For typed or written entries, give: Name — last first, middle; ID no. (SSN or other); hospital or medical facility)
EMERGENCY CARE AND TREATMENT (Patient)
Medical Record
Eporar(vo-k\ STANDARD FORM 558 (REV. 9-98) Prescribed by GSMCMR
FPMR (41 CFR) 101-11.203(b)(10) USAPA V1.00
MEDCOM - 20051
DOD-033625
NSN 7540-01-075-3786 TIME SEEN BY PRckVIDER
EMERGENCY CARE AND TREATMENTMEDICAL RECORD
(Doctor)
TEST RESULTS
Check if read by
WBC ABG/PULSE OX RADIOLOGY radiologist
H/H U 4 2 SUP 02 PH P02 RESULTS
PLT PCO2 SAT OTHER
DIP EKG INTERPRETATION
p-r
BHCG ETON GLU MICROAPTr PROVIDER HISTORY/PHYSICAL
Oc. 9-1-
G-c5-
,
L 4144---/Gq)-1,- -4 LI /€1
e
k I` 64-f-"E-4/4
TIME ACTION RESIDENT/MEDICAL STUDENT SIGNATURE AN TAMP
CONSULT WITH PROVIDER SIGNATURE AND ST
ci,)(6)*
DIAGNOSIS
1r
to
0
c.
(For typed or written entries, give: Name — last, first, midcfie:
PATIENT'S IDENTIFICATION
iD no. (SSN or other); hospital or metrical focally)
EMERGENCY CARE AND TREATMENT (Doctor)
Medical Record
STANDARD FORM 558 (REV. 9.96)
Prescribed by GSNICMR FPMR (41 CFR) 101-11.203(b)(10) USAPA VI.00
. . -`"'"-
MEDCOM - 20052
DOD-033626
MEDICAL RECORD PREOPERATIVE/POSTOPERATIVE NURSING DOCUMENT
For use of this form, see AR 40.66; the proponent agency is The Office of the Surgeon General.
1. AGE: 2. KNOWN ALLERGIC SENSITIVITIES (e.g., Iodine, Tape, Medication):
(6 /UK
HEIGHT:
3. PREVIOUS SURGERY j NO N..!: YES (type): S.21:._ 114-4P
WEIGHT:O (05
4. PROPOSED SURGICAL PROCEDURE:
r 0
Cel-eba\
5. ADDITIONAL
MATION: Last Pakic.41
I-Ix: 111-Implants; q Medications: Ci'
r -2
Jewelry remove : yes/ lo Family waiting: yes
6. PATIENT PROBLEMS AND NEEDS
7. PATIENT GOALS AND EXPECTED OUTCOMES
8. OR NURSING INTERVENTIONS
A. PSYCHOSOCIAL o Allow pt. to verbalize
o Pt. verbalizes any specific anxiety.
freely.
— Potential for anxiety p ain OR environment
o Pt. exhibits relaxed bod re. and answer questions
related to traumatic injury;
regarding surgery.
language barrier; family
o Offer comfort measures,
separation; surgical environment
(e.g., warm blanket, touch)
o Explain all nursing procedures before they are done.
o Remain with pt. whenever possible.
o Maintain family interface.
B. AERATION PT be able to breathe without
(Q____Offer to elevate head ofential for iculty during immediate intralitter or offer pillow.
operative phase.
respiratory dysfunction due to e_-019serve pt. while awaiting
sedation; positioning; injury surgery for signs of distress
QAasistAngEiliesia durtrgi4t4laatierraftEl-extuttation,
:o—PT. will not exhibit signs of impair-
C. INTEGUMENT tL—Utilize pressure preventing
ment of skin integrity (e.g., reddened
devices on OR table and 61erdial impairment areas. accessories.
of skin-inie—giitydtre-to cr for proper
boy ie positioning and support to
pad; position; fluid
maintain good bodyialignment. Ead-pzessure points.
o Pface ESU ground pad on non compromised skin surface area.
Kee p fluids from
ing.
9. PATIENTS IDENTIFICATION (For typed or written entries give: Name- last, first, middle; grade; date; hospital or medical facility)
IF 00)(0,1i.
DA FORM 5179, JUN 91
Previoius editions are obsolete.
USAPA V1.01
MEDCOM - 20053
DOD-033627
6. PATIENT PROBLEMS AND NEEDS
D. CIRCULATION
rential for inade-
quate tissue perfusion due to
anesthesia; traumatic injury;
position; shock; previous surges y
E. NEUROMUSCULAR
CONTROL:. . r _...----i Potential impairment
E
of mobility due to sedation; pain; injury
E.2. _L___gete-ntial discomfort
due to injury; pain
F. NEUROMUSCULAR
CONTROL
Disminished visual
F1.
perception due to being injury:
sedation;
Potential for decreased
F 2 communictaion due to !angina
harrier; sedation f _-----
I'
F.3. Poysnlitrinjury due to
dentures.
...-
G. OTHER PATIENT PROBLEMS
NEEDS. Or continuation of above
problems/needs.
1
10. O
7. PATIENT GOALS AND EXPECTED OUTCOMES
Q,....-Prwill exhibit signs of adequate tissue perfusion (e.g., color, warmth, pedal pulse).
9--Pt. will be transferred to OR table
without difficulty.
o___P-4,-will not experience unnecessary
physical discomfort.
o Pt. will be made aware of surroundings prior to anesthesia induction.
o Pt. will be transferred safely t.
OR
table.
o Pt. e able to understan ructions.
o Minimize e, ring intra
.
OTHER PATIENT GOALS AND EXPECTED OUTCOMES. Or continuation of above goals and outcomes.
8. OR NURSING INTERVENTIONS
6--C1-eck for support stockings or ace wraps. If none, check with doctors. ,.9-entn that safety straps are correctly applied.
49-0114r . Pillow for under knees. 0 Place and take down legs from stirrups with slow bilateral motion.
Stuask-ttrallings have been
removed.
45--i-Inve sufficient people
available for transfer.
V..frrs'Gre proper body
alignment.
Q_Allow patient to lie in
position of comfort while
waiting for surgery.
er—Offer support (i.e., pillows,
bathtowels, etc.) for
positioning.
o Introduce self. Keep pt. inform-. , • if ere he/she is ; • what is happening.
o Inform pt. in which direction to move and assist if necessary.
o Speak clearly and slowly.
o Address pt. from
side.
o Validate pt.'s
understanding of verbal
communications.
o Verify removal of dentures.
OTHER NURSING
INTERVENTIONS.
Or continuation of above
interventions.
..
OMPLETED/ADDITIONAL INTEROPERATIVE INTE ENTIONS NOTED. it 03
-, C ,2/,,-- 4S'DATE
, PO " ERATI EVALUATION:,' . r) I ; I _ ../
s-`.) A0
r4-• C
3. PaS PERTIN/EEVALLEPARED
/6 ature / WO
USAPA VI.01
REVERSE OF DA FORM 5179. JUN 91
MEDCOM - 20054
DOD-033628
1
MEDICAL RECORD iNTRAOPERKI ,VE DOCUMENT
For use of this form, see AR 40-407, the pr ,
t agency is the office of The Surgeon General.
1. PAT ENT TRANSPORilp TO OPERATI
2. PATIENT IDEN
RECORD R WED AND PROCEDUREVIA ;1 _ f, iffer-BY / e , C. VERIFIED BY C,47 I
0 (.1
3. DATE TIME PATIENT ARRIVED IN SUITE 4; PATIENT IN ROOM
(7.,
,i 3(-_-.)
pf:i s6-Pc 3 TIME ;(--- F-/ - /
3 C-..' NUMBER
5. PREOPERATIVE EMOTIONAL STATUS
. CALM • ANXIOUS ¦ EXCITED. • CRYING • ANGRY ¦
WITHDRAWN
W)THER (Specify)
COMMENTS: Nal
/Fl Al 4 cdCo .-.
6. NURSING PERSONNEL
SG---r-0
ASSIGNED
, 74-1-----RELIEF
SCRUB
. SCRUB
00) (-
.1 (.10)C(0)2g---
ASSIGNED CA' T
66C RELIEF Cpr 4)6 E. (o I zo -
CIRCULATOR it
. .. —_CIRCULATOR
(.(0) Ccs_ ...
iltll :-
7. POSITION, ,ANp POSITIONAL AIDS ISpecifylipl
oa" .poceG-6..-11._ cyg_.`,454 -a-Ck
liVLS co t LA, ex .. 014
'F.UPINE PL -5 k 1-3 , oci rvt CLOGS..Q. .X.7 411-5 tA ettier-hod •
A
th 4-ittAdet5 4--1--tAct-k-eo-I ,-, cL9 nt C__ yr.1 . -Yrs_ q eri d .9.../1 ') /3 iri4 A.
¦ LITHOTOMY
. PRONE III KRASKE. -; . LATERAL: LEFT SIDE UP 0 RIGHT SIDE UP
..
•-:...;:....:..
COMMENTS :
Co ( f 004 /03,4-1 Ivt-e--..---cl 0614;11r¦ -44;11...e. (I
8. SKIN PREPARATION
HAIR REMOVAL 'RI YES NO¦ • PREP S01.UTION (Specifyl
-BeA-Ci d I r1.4.-
DONE BY: OR . NURSING UNIT SITE:I.L. )G-r-0 i r-N -. :1 f k 4-
BY WHOM: 56_7-"NMMETHOD: . DEPILATORY -j2,RAZO . SITE: BY WHOM:
¦ CLIP
6/-CCr 'NA-*-. r 03X.(1) t/
COMMENTS: la r,
"‘c., k5 or m4h ,1-.0-1,-..COMMENTS: n. 0 7ii.kj.., ai.s011.47cCrlS 40
9. LOCATION OF EXTERNAL DEVICES
.
•-• ..--11-44 .
tki7.15 railed 6_
giller yfiel.'
,,,rillibmow Sea, -• •
arca; --
—........„,„1.1„,..-
_. VIVAPP-
.. ... -
,,,,,.46,..-. .
4
LEGEND Ir • -two AO
X Ground Pad --afety Strap = = = Tourniquet- - ,*.•• •, -• -r --r .
•.
C = Correct I = Incorrect
First Closing. Final Closing
10. COUNTS
Other•• Count CoUnt
..:-4. -SCRUB
CIRCULATORSponge jYes
MI-o ,IiiillEMINI ••
741.1i
Needle Sharp es q o
..........
...sf,-1 e P.
Instrument Yes
o __..../-..
... -....
Other Yes mi o 7
11.
PATIENT IDENTIFICATION (For typed or rirren entriesgive: 12.:ELECTROSURGERY DEVICE(S) (ESU)
Name - Last, first, middle; Grade; Date; Hospital or Medical Facility;) ¦ YES
. ESU NO: ( OW --q GROUND PAD: BRAND -• --,..-
., LOT NO:
reF ii s ..1iir.E-5:0-NO:
i ,. .
.,.• -:-GROUND PAD: BRAND
LOT NO: III BIPOLAR NO:
DA FORM 5179-1 nr-r. f27 DCDI Ikf•Ge nit MEDCOM - 20055 USAPA V1.00
DOD-033629
13. PROSTHESIS, IMPLANTS • YES IC) IF YES NAME: ID NUMBER IFACTURER
t
c : .: :•:;
.
?.14. grgnitrVg,MV„Willelf:,t1:;.,:tfiSti: . , ' ,i'MEDICATIONS/ORDERSMV ,i,„MrZi.., j,-,1:1;?:;;IM-21:: r ''' .' :,1":*:114,24
:1,ri!,,I1VO48: IRRIGATION/MEDICATIONS GIVEN IN OPERATING ROOM (NOT BY ANESTHESIA) YES NO • IIVIEDICATIONS/SOLUTION TIME -METHOD PREPA 0 BY GIVEN BY
P t) .,ot, - -„ ,,. Ai. ...1.1, ¦ : i _ Li D
51l4 , .. ki Mr1/11111/M1Mr” •• A. aAIMI
it , : . 4-r" --47# ' llESIM : .
1
WOUND IRRIGATION • YES VAIO, TYPE(S):. . -.
,,. .
-OTHER ORDERS TIME CARRIED OUT BY !i .c
t_...., ...:..,
.;PHYSICIAN'S SIGNATURE -s,
15.
X-RAY IN OPERATING ROOM, IF YES, SITE
YES W NO • Wt.-1 eC) Li I o¦ ettil' rrl• Ur i ake "x2di Wail'
16.
- ' -7;4.ABORATORY SPECI1AENS
. .„,
SPECIMEN (S) NAME ' -.-__:,_____-- -NAME
.
. : , - :: ,
YES 0 NO
FROZEN SECTION IFS) NAME 7 . : . :" NAME
YES 0 NO 40)
CULTURE IC) NAME -NAME
YES • NO -......... -,..._
. .
NAME ' NAME NAME
NAME NAME - 18. DRESSING/IMMOBILIZATION (Specify)
. _ ps ,
17. TUBES, DRAINS/PACKING YES 0 NO
TYPE/SIZE 1. 2.
SITE 1. 2. 3.
19. ADDITIONAL INFORMATION . .
Wc-r .
Dc +4).\-e.
_ ......
-— - •
(1'49) -7---
. : - • - - :- • : .:
!
. .. .. . . . .
PA F03,-. 519q i nt‘baj-ei
20. OPERATION(S) PERFORMED
CQ,re 'Dr al pir-t-rio,i_c-, rcl ne-x.
.
V .: .
21. PATIENT TRANSFERRED TO TIME ET / / I
MHOD
Ctit "3 / 6 / (.-ki/tieteel Miele,,---_
-24.11111Msmrcbyo-a_ MEDCOM - 20056
GM -41 ElMiligir errblo)
DOD-033630
OM MEW IMME
NEMINSIERIEFES
Eimmimisminir 111111131
INIZIEEN IMEL
tells= olomumainn.
PRIONIIMEMBI HEM
INESIMINESEICIFFs° 13 -11111111EN
smiammumolovoquont
CHEMEIRIMMEMENERWIBP
MIM BE 11 Aitalk
IMI33
MENNEHIEMPi MEM
1111011111111111111
0=
11111O
111111111111111111111111‘
a
"n1
ii L d
BM 111111111111111111111
s.0 4 -tA
c?, c 0 m
1111211,11:111111111112111111:11/
C, 0
O
r
1 inn hlIMMENSI m
m
§e ii-MENEEZINISIKEiliiii
5111171113011111111312111113111Elv
1111111110111=111:
1011011111311EMIEEPESSEISIONI
IIESEEPESEMISIIIIMEOW3313111.
9111111111NEMINIMINAlli
1111111101110111111111111110 .
Hinuoimiumi 0
1.
co
m
O
(.4
Co
1111111111111 i P -0
Isl
m
co
1111111111.11111111111 O 1,
MEDCOM - 20058
w
a
...... m
ii
iii c is N
Rim 0
!ate RIM m
C
All-i hin adPO
Fl -gib m
monosizadiumenaliii
1ii IMISIZEMES
IIIIIMME012211 311
Ilk a 'T AO 9111EMEIMEOW LISE
qqm
iii -q,z4,,A11 EWEN ma
III11111111111 111
.
1111Ili.
1I4I
I 1
MEDCOM - 20059
rr.
DOD-033633
Ward/Sectio.I. S1CAN: (b)( 4) _,s1....,.ABORATORY RESULT FORM
1 L (Subject to the Privacy Act of 1974)
LA.gi • , D ATE TIME SSN/PEEUDO BSN:
O'' •
00)(4-Li D
'3. 27g, . „ ,,,.. ; .-:: ,s;.`wAitt:t4 ,..ume• 6,...s. ;
-t. -, t3-mAmo. ,„, , , , -§ '.'''v' ' "..4.".'* ,-' ' te ' -_, 4tva.
,ix,.-:,4 ',„.:,,c.' ..'`)..,. wt,,..k°.,,••g, -., ,:4* eke. 'As, ° At41 ..,.4'.; 4itt irf.i. Avarioly
''', -t,
TEST RESULT REF: RANGE TEST RESULT REF RANGE TEST RESULT REF RANGE
WBC 4.8-10.8 xib Color N/A RPR Negative
RBC Hgb Hct 4.7-6.1 x id 1-18 g/dI(M) 12-16 g/d10) 42-52%(M) 37-47%(F) App (Au Bili N/A Negative Negative Mono v...:4Art .0:0:1*,. Source Negative -5, W' 94* lit,
MCV 80-94 G(M) 81-99 fl(F) Ket Negative Gram Stain
Pit 130-500x10' verified SG N/A Occ Bid. Negative
Lymph % 20.5-51.1% Bld Negative 11. pylori. Negative
\„, k , ' ' % . . , ;.:„,' '”' '',!°: ,4";044,q " ' R ,, ''' 5 , T.,.: .t., -.... ,...,k.. '.ik Wia,. , -TTpH N/A Micro Parasites
Segs.1 Mono Prot Negative Malaria
Bands Eos Urob 0.2-1.0 0 & P
Lymph Baso Nit Negative Other
Atyp hum Leuk Negative ,0
RBC HCG Negative
Morph
Spun Hematocrit 42-52%(M) 37-47%(F) , - -,' ,,,,,,),* . ir , ,.. i 4 :?. . ... Fz
Set Rate Cell Count MUST SUBMIT SF 518 WITH EVERY UNIT REQUESTED
Other
TEST RESULT REP: RANGE UNIT TYPE CROSSMATCH
Pr 9.8-13.6 secs
APTT 21-34 SESS D dimer 20 ughnl FDP 10 ug /m1
REMARKS:
REPORTED BY: DATE:
LAB ID NO.:
MEDCOM - 20060
DOD-033634
Ward/Section: REQUESTING PHYSICAN:
CHEMISTRY RESULT FORM
(Subject to the Privacy Act of 1974)
LAST, FIRST,MI. DATE TIME SSN/PEEUDO SSN:
.,
?•., ,t '-', wv , -4v• ,,. ,, li 4 kte_r3s'
-- ' 44 . -rrl ,
.....„ 4*..,A3,44# • ''', -...-.At , .,. A, - In `'. 04,giv,,,w
, atedasiwors -, , ,o., 4"
TEST RESULT REF: RANGE TEST RESULT REF. TEST .RESULT REF RANGE RANGE
Na 138-146 nunol/dL ALB 3.5-5.5 Oil 73-118 rag/d1
GLU.
K 3.5-4.9 mmoUL - -
os 4 OA ••111
7-22 mg/d1
BUN.98-109 nanoUL. 8.0-10.3 mg/di
CA ++.
.PICCOLO
pH 7.31-7.45. 0.6-1.2 mg/dl
CRE.
09/22/03 07:5G III
PCO2 35-45 mmHg (art).128-145 mmol/d1
REFEHENcE RANGE
41-S1 mmHg (yen) : MAI !-NA+.
P02 80-10S mmHg (art).PATIENT 11 : ill/ 63X0-1 K+.
3.3-4.7 mmol/N/A ven.
NET L YTE 8
23-27 mmoUL (art) CL_. 98-108 mmol/1TCO2 24-29 world& (ven).DISC LOT # : (616) I-3152,'M
HCO3 22-26 unison (art).OPER # BIN
DR #: 000 tan. 18-33 mmol/123-28 mrnoUL (art .
SERIAL # • (012
SO2 95-98% .0:1WIOAWIAWiii 'P
)1 .
kt".W0g10, ,N-•'' W •' '4'.4%
BEecf (-2) - (+3).GLU
120* 73-118 MGM_ TEST RESULT REF RANGE
mmolli,
AnGap 10-20 nunoUL.SUN 5* 7-22 MG/f11_ ALB 3.3-5.5 g/d1
CRE' 0.6-1.2 MG/DL
Ca 1.12-1.32 mmoUL. ALP 26-84 u/1
CK 825* 39 380 /L
BUN 8-26 mg/dl. ALT 10-47 nil
-12'3*.
128-145.MMOIA
GLU 70-105 mg/di.
K-f 4.1 3.3-4.7 MMOI,1_ AST 14-97 u/I CL-102 98-108 MMOtt
Creat 0.7-1.5 mg/dl.tCO2 17* 11-38 u/I
18-33 MMO1A_ AMY
Hct 38-51% PCV TBIL 0.2-1.6 mg/dl
INST OC' OK CHEM GC* OK
Hgb 12-17 g/d1.Hal 0.).LIP 0 GGT 5-65 u/1
, ICT 0
1 ,L.P '.. TP 6A-8.1 Wdl
TEST RESULT REF. RANGE . w 0 '
'-'4
Tropoin-1 TEST RESULT REF RANGE
Drug of
NA+ 128-145 mmoUI
Abuse
K 3.3.4.7 mmol/1
CL 98-108 mmol/1
tCO2 18-33 mmo1/1
• I
..
REMARKS:
REPORTED BY:
DATE: LAB ID NO.:
MEDCOM - 20061
DOD-033635
LABORATORY RESULT FORM
(Subject to the Privacy Act of 1974)
4.8-10.8 xlb
4.7-6.1 x18
14-18 g/d1(84)
12-16 g/d1(F)
42-52%(M)
37-47%(F)
80-9411(M)
81-99 fl(•)
130-500 x10'
22-09-03
11025
Patient
Wits EC 15.1 11 x10.3/at 4.5 10.5 RIC 4.64.x10"6/eel 4.00 6.00 NA 12.1.gist.11.0 18.0 It 37.6.Z.35.0 60.0 MN 81.0 fL.80.0 99.9 1131 26.11. pg.27.0 31.0 MCHC 323 L MIL.33.0 37.0 Plt 236,.1101/IL 150. 450. LYZ 9,7 •1. Z.20.5 51.1 11W.1.5 • 1101/11..1.2 3.4
MUST SUBMIT SF 518 WITH EVERY UNIT REQUESTED
MEDCOM - 20062
DOD-033636
Wardierit. RE.ICAN:
CHEMISTRY RESULT FORM ( 0( 0-0— (Subject to the Privacy Act of 1974)
LAST, FIRST,MI. DATE SSN/PEEUDO SSN: t6)(4 ) q Z1-50. 7 , )0,10*.ikk Vivw,;q: titiW , .4Metabolic. '. tztRil
wevilt: , .: ,.:':„...:...:1-;,:::, -,e%,„,.. ,,,:%:.: ig,,c5,441,4:, ,:,...,„ , egvligs•-93a. 4-viix***.‘staloutomovv*.eil,t-:„,gatAi t
TEST RESULT REE RANGE TEST RESULT REE TEST RESULT REE RANGE RANGE
Na 138-146 nunol/dL ALB 3.5-5.5 g/d1 73-118 mg/d1
GLU
K • 3.5-4.9 nunol/L ALP 26-84 tan 7-22 mg/d1
BUN
CI 98-109 nunol/L ALT 10-47 u/I 8.0-10.3 mg/d1
CA++
pH 7.31-7.45 AMY 14-97 u/I CRE 0.6-1.2 mg/all
PCO2 35.45 mmHg (art) AST 11-38 u/1 128-145 mmol/d1
NA+
41-51 mmHg (Yen) P02 80-105 mmHg (art) T1311, 0.2-1.6 mg/dl K+ 3.3-4.7 nuno1/1
N/A (yen)
23-27 nunol/L (art)
T C 02 BUN 7-22 mg/dI CL 98-108 =non
24-29 nunol/L (yen)
22-26 mmol/L (art)
HCO3 CA mg/d1 18-33 mmol/1
tCO2
23-28 mmol/L (art)
SO2 95-98% CHOL 100-200 mg/d1
BEecf (-2) - (+3)
CRE 0.6-1.2 mg/dl TEST RESULT REE RANGE
nunol/L
AnGap 10-20 mmol/L GLU 73-118 mg/dl ALB 3.3-5.5 g/dl
Ca 1.12-1.32 nunol/L TP 6.4-8.1 g/dl ALP 26-84 u/I
BUN 8-26 mg/d1 ". 9'. % L 11 -e. , 0 • 4,-, ALT 10-47 u/I
ErMigt,,,MS,ASV:%VOS: 43P4r, ' -2' Rit:
GLU 70-105 mg/dl TEST RESULT REE AST 14-97 u/I
RANGE
Creat 0.7-1.5 mg/d1 73-118 mg/di AMY 11-38 till
GLU
Hct 38-51% PCV BUN 7-22 mg/di 'reit.. 0.2-1.6 mg/d1
Hgb 12-17 g/d1 CRE 0.6-1.2 mg/di GGT 5-65 u/I 5.%,. ireSv- 0 k„a.., rou., 1..1,9,.„ , .-,•,,,M1,4:4 CK 39-380 /1 (M) TP 6.4-8.1 g/d1
TEST RESULT REE RANGE NA+ 128-145 mmolft witaq.'' 4*) Elccirolytc
3.3-4.7 mmol/1 TEST RESULT REE RANGE
Tropoiu-1 le
Drug of 98-108 ouno1/1
Cr NA+ 128-145 mmol/1
Abuse
1CO2 18-33 nurtulll K÷ 3.3-4.7 mmol/1
CL-98-108 mmul/I
tCO2 18-33 nuno1/1
REMARKS:
REPORTED BY:
DATE: LAB ID NO.:
MEDCOM -20063
DOD-033637
LABORATORY RESULT FORM
(W914 (Subject to the Privacy Act of 1974)
2-09-03
16:30 Patient
Units WC 15.1 H x101341. 4.5 10.5 RIC 4.82 110"6/et 4.00 6.001196 12.7 9/dt.11.0 ILO Hit 39.1 Z.35.0 60.0 CV 81.1 ft.80.0 99.9 ID 26.3 I P9.27.0 31.0 Mit 32.4 1. 9/111..33.0 37.0 Plt 254,.x101/al. 150. 450.
Ll 9.1 *I. Z.20.5 51.1 L il 1.4 * 2109/11..1.2 3.4
W., ,,17144
:44fttaa*
14att '.•.•
•
REPORTED BY: DATE:
LAB ID NO.:
MEDCOM - 20064
DOD-033638
CHEMISTRY RESULT FORM (Subject M the Privacy Act of 1974) DATE TIME SSN/PEEUDO SSN:
WO-
.1'44-11
AU,
TEST RESULT REF RANGE TEST RESULT REF: TEST RESULT REF. RANGE RANGE
N 138-146 mmol/dL ALB 3.5-5.5 girl] 73-118 mg/d!
GLU
•--
K 3.5-4.9 mmol/L 722 mg/dl
BUN
98-109 nunol/L &040.3 mg/dl
CI CA++
==----- PICCOLO -----
pH 7.31-7.45 09/22/03.CRE 0.6-1.2 mg/di
01:32 FM 35-45 =dig (art) REFERENCE RANGE:.128-145 mmol/d1
PCO2 MALE
NA+
41-51 mmHg (ven)
PATIENT #1111,(9(041
P02 80-105 mmHg (art) 3.3-4.7 mmol/1
N/A (ven) METLYTE 8 TCO2 23-27 nunon. (art) DISC LOT Ro-z 3152rX1 CL-98-108 mmolll
24-29 mmol/L (ven)
OPER #: DR #: 000
22-26 nunol/L (art) 18-33 nuno1/1
HCO3
tan
23-28 minoUL art SERIAL #'
SO2 95-98%
5N, IfititVeartagis4
BEccf (-2) - (+3) GLU 121* 73-118 MG/OL TEST RESULT REF RANGE
mmoUL
BUN 5* 7-22 MG/DL
AnGap 10-20 mmol/L ALB 3.3-5.5 01
0.7 0.6-1.2 MG/OL
CRE
Ca 1.12-1.32 mmol/L
CK 849* 39-380 U/L tLP 26-84 u/I
BUN 8-26 mg/dl NA + 127* 128:-145 1410M_ LT 10-47 WI
4.2 3.3 -4.7 MMOtiL
GLU 70-105 mg/dl K+ 4ST 14-97 u/I
CL -103 98-108 MOM.
tCO2 18 18 33 MOM .
Creat 0.7-1.5 mg/d1 11-38 u/I
Hct 38-51% PCV "BIL 0.2-1.6 mg/di
CHEM OC: OK
Hgb 12-17 g/dI.( HEM 0 , LIP 0 , ICT 0 ;GT 5-65 u/I
INST QC: OK.
6.4-8.1 g/dI
TEST RESULT REF. RANGE ? I
'ST RESULT REF: RANGE
Tropoin-I I
Drug of C 1+ 128-145 mmol/1Abuse
t( 3.3-4.7 mmol/1
98-108 nunoUl
32 18-33 nuno1/1
REMARKS:
REPORTED BY: DATE: LAB ID NO.:
MEDCOM - 20065
DOD-033639
LABORATORY RESULT FORM
(Subject to the Privacy Act of 1974)
RESULT REE RANGE TEST
WBC
Qi (6) "4
RBC
22-09-03
Hgb
03:39 Hct Patient Liaits MCV 1113C 17.2 H :101/51. 4.5 10.5 IDC 4.56 x10A6/aL 4.00 6.00
Pit HO 11.8 g/.. 11.4 18.0
Hct 36.9 Z 35.0 60.0
Lymph °A
IV 81.0 fL 810 99.9
719 L as 27.0 31.0
IOC 32.0 L 33.0 37.0
Plt 274. ItIOVIL 150. 450.
Segs LT% 9.7 11. I 20.5 51.1
LYI 1.7 * 110•3/aL 1.2 3.4
Bands
Lymph
Atyp
03:39
22/09/03.
RBC MALE
REFERENCE RANGE:.
Morph PATIENT It: an N(0...1
METLYTE 8
Spun
2_ 3141AA4
DISC LOT #:
Hematoc NO-
DR #: 000
OPER #:iii
Set Rate
SERIAL #: MON
'
04.4.rt
igen
GLU 126* 73-118 MG/DL
Other
BUN 7 7-22 MG/DL
CRE 0.7 0.6-1.2 MG/DL
CK 1002* 39-380 U/L
NA+ 139 128-145 MMOVL
K+ 4.6 3.3-4.7 MMOVL
TEST
CL- 105 98-108 MMOVL
PT
tCO2 22 18-33 MMOVL
APTT CHEM QC: OK
INST GC: OK.
HEM 0 , LIP 0 , ICT 0
D dime)
FDP
REMA LAB ID NO.:
REPO
MEDCOM -20066
DOD-033640
Ward/Section:
CHEMISTRY RESULT FORM (Subject to the Privacy Act of 19.74)
LAST, FIRST, 00) 41 -DATE_ TIME SSN/PSEUDO SSN:
(A)
if S
;44¦:•-?
:• 4 .
p.a'
TEST RESULT REF. RANGE EST.-. RESULT F.
TEST RESULT REF. RANGE
RANGE
Na
73-118 mg/dl
K
7-22 mg/d1
# PICCOLO -------------- PICCOLO
.
8.0-10.3 mg/dl
22/09/03.00:55.22/09/03.01:03
PH •
0.6-1.2 mg/di
REFERENCE RANGE: .REFERENCE RANGE:.
MALE . MALE .
PCO2 .
.
PATIENT #:11111, (01)i
P02.
METLYTE 8
DISC LOT ft:
.00_7_3141AA4
TCO2
OPER #:.
.‘is' DR #: 000
HCO3 •*)
SERIAL
sot
GLU.141* 73-118 MG/DL
BEecf
BUN 7 7-22 MG/DL
AnGap CRE 0.5* 0.6-1.2 MG/DL
Ca CK 998* 39-380 U/L
NA+ 139 128-115 MOVE
BUN K+.3.3-4.7 MMOE/L
3.9
CL.
106 98-108 MMO&L
GLU
;
tCO2 21 18-33 A MOW_ Ri Creat
PATIENT #: 1/1/ (40_y
GENERAL CHEMISTRY 12
DISC LOT #: 16/0-1_3204AA4
OPER #111111,"" DR #: 000
SERIAL #'
1(.411-41111.111110
ALB 3.5 3.3-5.5 G/DL
128-145 mmol//
33.4.7 cumuli!
.
98-108 mmol/1
.
18-33 mmolA
r: A
ALP 117* 26-84.ILT REF. RANGE
U/L
ALT.
30 10-47.
U/L
33-5.5 01
AMY.
38 14-97.
U/L
26-84 u4
AST.
43* 11 -38.
U/L
10-47 &I
TBIL 0.5 0.2-1.6 MG/DL
BUN 7 7-22 MG/DL
CA++ 8.6 8.0-10.3 MG/DL
CHOL 106 100-200 MG/CL
INST OC: OK.CRE 0.7 0.6-1.2 MG/DL
Het CHEM QC: OK .
HEM 0.
LIP 1+3 ICT 0 GLU 147* 73-118 MG/DL
TEST
Troponin-
Drug of Abuse
REMARKS:
REPORTED BY:
TP 7.0 6.4-8.1 G/DL
22-09-03
00:54 Patient
Lieits WC 18.1 H x10"3/IL 4.5 10.5 DC 4.96 :10"6/eL 4.00 6.00 HO 12.9 g/d1. 11.0 18.0Hct 40.3 I 35.0 60.0 ICV 81.1 fL 80.0 99.7 IEN 26.1 L pg 27.0 31.0 IENC 32.1 L g/dL 33.0 37.0
Plt 276. 1110'3/aL 150. 450.
LYZ 12.9 *L I 20.5 51.1 LY8 2.3 * x10"3/eL 1.2 3.4
14-97 u/1
11-38 u/1 0.2-1.6 mg/dl 5-65 u/1
.„
4
YL-7!=%1F. RANGE
128-145 mmol/1
3.3-4.7 mmol/1
98-108 mmot/I
18-33 truno1/1
MEDCOM -20067
•
Ward/Section: REQUESTING PHYSICrAN:
LABORATORY RESULT FORM
LAST, FIRST.,..ML DATE
TIME • SSN/PSEUDO SSN: . --
• • -.1....046210iogy) cBC :, . • - . :,....:. -... -..:. Ftnilysis . .. ..,
i . ..Misce'Se.rolagy : :-.. . :.
, .. . . ..• . ./TEST RESUL_T_---RE.F. RANGE TEST RESULT REF. RANGE
TEST RESULT REF. RANGE -
4.8-10.8 x 10' Color • N/A RPR ' Negative —
.-V.0'
RBC------_____.—A-7-63-5C10 ppp N/A
Mono Negative
Hgb 14-18 g/d1(M) Glu Negative
-
.„ - . Kterobiology .
12-16 g/d1(F) . ....•• • .. • -. :... .• ... •. ' - •
Het 4702% (M) . Bili Negative
Source
37-47iY0 (7) . . : MCV 80-94 II (M) ICet I Negative --'• ....
Grim -
81-99 fl (P)
.
Stain
Pit • 130-S00 x 10'
SG WiA. . °cc Bld Negative
verified
Lymph % " :. 203-51.1% • Bld Negative IL pylori Negative
....:. (170112014y) WituaI Differeatiil '..- -:-... pH • N/A . Micro .:. • -
. . . , . . . . .. . ..,.. -
.. ... .. .. . . _ ... Parasites i
•
Segs • Mono Negative
Prot Malaria • Bands . Eos Urob 0.2-1.0
0 & P •
Lymph Baso Nit Negative Other . --
Atyp 1mm I Leukv Negati e
' .. :-.1%*ioscaiik Urinalysis: : •
RBC HCG Negative Morph
•'
.
• /I._••• ¦•• • •_.•_...... ._
^-- _ Y -
Blood.Ba4
. '
Hematocrit 37=47• (F) • • . .
. • • • -
Sed Rate
Cell
MUST SUBMIT SF 518 WITH Count EVERY UNIT REQUESTED
Other Directigen Negative
ABO/Rh I po,.
loOd -Balk : - -(MUSiSUBMCK.S.F:518.V.VFF.R.F.YER .•,- • • 1 .!-
TEST---REF: RANGE UNIT TYPE CROSSMATCH
PT 9.8-13.6 secs
APTT 21-34 secs
D dimer 20 ug/m1
FDP 10 ug/ml
REMARKS:
REPORTED BY:
BY:
MEDCOM - 20068
DOD-033642
RAPIDPOINT CDC ANALYZER V4.54 SERIAL OM 09/22/03 '12:57 AN
Pat lent ID:. Test Name :APT' ow0-4-1 Test Result:= 45.9 sec. ***RESULT NOT RANGE CHECKEL444
Sample Type:citrated wh, blood
Test Date :09/22/03
Test Time :12:55 AM
Card Lot
:100208
Operator :MEW
00Y )—
WO 4-
RAPIDPOINT COAG ANALYZER V4.54
sir:At 11111108/27(13
01:04 AM
Patient ID: Test Name :PT lest Result: = 15.4 See • 44 *RESULT NUT RANI
(IRKED***
Ratio = 1.3
Calculated INR.
1.46
Sample TYPe:citrated wh. blood
Test Date :09/22/0J
Test Time :01:01 AM
Card Lot
:010301
11111111/ Co1,6)
MEDCOM - 20069
DOD-033643
Microbiology Report
ABN SINA - lili
aTAL Laboratory
Name:
Specimen: : Status Final
Patient ID: 1111 .14,(f)
Source: Sputum (6) (6) —1/41 Collected:
Ward/Rm:
Ward of Iso: Attd. Phys:
Staphylococcus aureus
Status: Final
1 S. aureus
MIC Interns Drug MIC
Interns
AmoyJK Clay (c) =4/2
Amp/Sulbactam (c) =8/4
Ampicillin 8
BLAC
Azithromycin =2
Cefazolin
=8
Cefepime =8
Cefotaxime (c) =8
Ceftriaxone (c) =8
Cephalothin =8
Chloramphenicol =8
Ciprofloxacin =1
Clindamycin =0.5
Erythromycin =0.5
Gatifloxacin 4
Gentamicin =4
Imipenem (c) =4
Levofloxacin =2
Linezolid 4
Moxifloxacin
=2
Nitrofurantoin
=32
Norfloxacin
=4
Ofloxacin
=2
Oxacillin
NIR
Penicillin
8 BLAC
Pip/Tazo (d) =4
Rifampin =1
Synercid =1
Tetracycline =4
Trimeth/Sulfa =2/38
Vancomycin =2
S = Susceptible N/R = Not Reported
I = Intermediate Blank = Data not available, or drug not advisable or tested
= Not Tested ESBL = Extended spectrum beta•actamaseR = Resistance
TFG = Thymidine-dependent strain
MIC = mcg/mt (mg/1.)
Bloc Beta-lactamase positive
f• I I
= Resistant clue to extended spectrum beta-lactamases (ESBL)
EBL? = Suspected ESBL. Confirmatory tests needed to differentiate ESBL from other beta-lactamases.
IB
Inducible Beta-lactamase. Appears in place of Sensitive with species known to possess inducible beta-lactamases; potentially they may become resistant to alt beta-lactam drugs.
Monitoring of patients during/after therapy is recommended. Avoid other/combined beta-lectern drugs.
For blood and CSF Isolates, a beta-lactamase test is recommended (or Enterococcus species.
(a)
(b)
Usa maximum doses of drug with an aminoglycoside for P. aeruginosa in patients with granulocytopenia or serious infections.
Breakpoints based on parenteral dose. For cefuroxime axetil (P0) use (8=S, 8-16=1, 16=R). Footnote (c) applies to this drug.
(c)
For streptococci refer to penicillin interpretations. For amoxicillin/K clavulanate or ampicillin/sulbactam with enterococci, refer to the penicillin interpretation.
(d)
For non beta-lactamase producing enterococci, refer to the penicillin interpretation. Footnote (a) also applies to this drug.
Interpretive breakpoints are based on NCCLS M100-S12 Jan 2002. Sparfloxacin (for Gram Negative isolates) and moxifloxacin are based on FDA approved breakpoints. For S. pnaumonlae, cefotaxime and ceftriaxone breakpoints
are based on isolates from patien meningitis For non-menin itis infections, use 2=S, 2=1 2=R.
Name: Specimen: 9Status:Patient ID: (4)~
(0 )-9 Source: Spu m Collected: Final (b)(0Ward/Rm: Req. Phys: alia/C.1:2
MEDCOM - 20070
n P.m 1,-)nry5 n.4 0..4 4 . •
_ . T ti
DOD-033644
Microbiology Report
ABN SINA Lpboratory
Name: Specimen: Status: Final
01) (b)(0)q
Patient ID: OM Source: Sputum Collected:
Ward/Rm: / t I RAA Z. 1 Best Ward of Iso: Attd. Phys:
4
1 Staphylococcus aureus Status: Final
1.S. aureus
Interps u Amox1K Clay (c) =4/2 Amp/Sulbactam (c) =8/4 AmpiCillin 8 BLAC Azithromycin =2 Cefazolin =8 Cefepime =8 Cefotaxime (c) =8 Ceftriaxone (c) =8 Cephalothin =8 Chloramphenicol =8 Ciprofloxacin =1 Clindamycin =0.5 Erythromycin =0.5 Gatifloxacin 4 Gentamicin =4 Imipenem (c) =4 Levofloxacin =2 Linezolid 4 Moxifloxacin =2 Nitrofurantoin =32 Norfloxacin =4
Ofloxacin =2 Oxacillin N/R Penicillin 8 BLAC Pip/Tazo (d) =4 Rifampin Synercid =1 Tetracycline =4 Trimeth/Sulfa =2/38 Vancomycin =2
pagi MIC priMIC Interps
S = Susceptible N/R = Not Reported Blank = Data not available. or drug not advisable or tested I = Intermediate — = Not Tested ESBL = edended spectrum beta-lactamase R = Resistance TFG = Thymidine-dependent strain. Blas = Beta-lactamase positive MIC = mcgiml (rngIL)
= Resistant due to extended spectrum beta-lactamases (ESBL) EBL? = Suspected ESBL. Confirmatory tests needed to cifferentiate ESBL from other beta-lactamases. IB = Inducible Beta-lacternese. Appears in place of Sensitive with species knoval to possess inducible beta•lactameses; potentially they may become resistart to ell bets-lectern (rugs.
Monitoring of petients during/after therapy is recommended. Avoid other/combined beta-lactam drugs.
For blood and CSF Isolates, a beta-lactamase test is recommended for Enterococcus species.
(a)
Use madmum doses of drug with an aminoglycoside for P. aeruginosa in patients with granulocytopenia or serious infections.
(b)
Breakpoints based on parenteral dose. For cefuroxime axetil (PO) use (8=5, 8-16=1, 16=R). Footnote (c) apples to this drug.
(c)
For streptococci refer to penicifin interpretations. For amcndcilfinn denulanate or ampicillin/sulbactam with enterococci, refer to the penicilin interpretation.
(41)
For non beta-lactamase producing enterococci, refer to the penicilin interpretation. Footriote ,(a) also applies to this drug.
, . Interpretive breakpckits are based on NCCLS M100-S12 Jan 2002. Sparfloxacin (for Grain Negalii isolates) and madtio:oscin are based on FDA approved breakpoints. For S. prieumoniae; celotadme and ceftriaxone brealexints are based on isolates from patents will meningitis. For non-meningitis Infections, use 2=5, 2=1, 242.
. _
Name: Status: ' Final
MEDCOM - 20071
Patient ID: 03)(6) JUUI. ,.Putum Collected:
• •11 II I I." •
DOD-033645
Microbiology Report
ABN SINA -AIL Laboratory Name: Specimen: 00) ( _Lf Status: Final Patient ID: Eli (.(0) (6) -(.Source: Sputum Collected:
1
Ward/Rm: / Ward of Iso: Attd. Phys: Staphylococcus aureus Status: Final
1.S. aureus
Drug MIC Interns Drug MIC Interns
Arnox/K Clay (c) =4/2
Arnp/Sulbactam (c) =8/4
Ampicillin 8 BLAC
Azithromycin =2 S
Cefazolin =8
Cefepime =8
Cefotaxime (c) =8
Ceftriaxone (c) =8
Cephalothin =8
Chloramphenicol
Ciprofloxacin =1
Clindamycin =0.5
Erythromycin =0.5
Gatifloxacin 4
Gentamicin =4
Imipenem (c) =4
Levofloxacin =2
Linezolid 4
Moxifloxacin =2
Nitrofurantoin =32
Norfloxacin =4
Ofloxacin =2
Oxacillin N/R
Penicillin 8 BLAC
Pip/Tazo (d) =4
Rifampin =1
Synercid =1 Tetracycline =4 Trimeth/Sulfa =2/38 Vancomycin =2
.
S = Susceptible NIR = Not Reported Blank = Data not available, or drug not advisable or tested
= Intermediate — = Not Tested ESBL = Extended spectrum beta-lactamase
.
R = Resistance TFG = Thymidine pendent strain Blec = Beta-lactamase positive
MIC mcgiml(mg/L)
Ft* = Resistant due to extended spectrum beta-lactamases (ESBL)
EBL? = Suspected ESBL. Confirmatory tests needed to differentiate ESBL from other beta-lactamases.
IB = Inducible Beta-lactamase. Appears in place of Sensitive with species known to possess inducible beta-lactamases; potentially they may become resistant to alt beta-lactam drugs. Monitoring of patients during/after therapy is recommended. Avoid other/combined beta-lactam drugs.
For blood and CSF Isolates, a beta-taclamase test is recommended for Enterococcus species.
(a)
Use maximum doses of drug with an aminoglycoside for P. aeruginosa in patients with granulocytopenia or serious infections.
(b)
Breakpoints based on parenleral dose. For cefuroxime axetil (P0) use (8=S, 8-16=l, 16=R). Footnote (c) applies to this drug.
(e)
For streptococci refer to penicillin interpretations. For amoxicilfinft clavulanate or ampicillin/sulbactam with enterococci, refer to the penicillin interpretation.
(d)
For non beta-lactamase producing enterococcl, refer to the penicillin interpretation. Footnote (a) also applies to this drug.
Interpretive breakpoints are based on NCCLS M100-S12 Jan 2002. Sparfloxacin (for Gram Negative isolates) and moxifoxacin are based on FDA approved breakpoints. For S. pneumoniae, cefotaxime and ceftrlaxone breakpoints are based on isolates from patio ' ningitis. For non-meningitis infections, use 2=S, 2=l, 2=R.
Name: Specimen: Status: Final
Patient ID: 11111 (1, c) —i SOUrCe:.Sputum 04 Collected: (6)1(,) .
°)() -11
Ward/Rm: I of Ign. Req. Phys: MEDCOM - 20072
.
. • - • . • nrnn rnesnn cul "".na •
Oimnim 1 of
Ter.h:
DOD-033646
Ward/Section:
REQUESTING PHYSICAN:
I CHEMISTRY RESULT FORM
, (Subject to the Privacy Act of 1974)
LAST, FIRST,MI. DA'
I
SSN:
.._ .i...h,Vi'
k°4NA„ - -
.a.a.,04AAl
--• -
09/23/03.
TEST RESULT "1:;¦13 1::3 F11.'R.F:'
-'
-" . RE':.' RAN'GE1 W
1-STAT ECB+ FITI RFNCi: RANGE :.
Mk I
PATIENT
N ALB Nyol.
73-118 mg/dl
Pt:11111i (0/6) -9 MET LY IF 8.
Pt.Ilame: .ALP DISC LOT #:.7-22 mg/di
i\ 07_ 3152iv:1.
C. ALT OPER #:.
19W IN # : o0u.
8.0-10.3 mg/41
SERI
ly..
flu.AMY
113 mg/dL.t(e) allIllIllr
10) ..0.6-1.2 mg/dlp,
BUN.6 m9/d1_.AST
GLU.73-118.128-145 mmol/d1
117.MG/U1.
Na 701)
---171T-rol/
BUN.7-22.
P. TBIL ' m MG/EX .
.3.3-4.7 mmo1/1
**
mmol/L CRE.m.0.6-1.2.
MG/1i .
T.
BUN
107 mmol/L..411*.39-380 {Jiff.
E CA++ NA+.128-145.
Ci .' CK.98-108 uuno1/1
TCO2.m.
a3 mmol/L.WOO.
18-33 M
AnGap.K+.3.3-4.7..
*** mmol/L.4.2.MMOft
, H .
rt CHOL 104 ft#
CL-.98 108 Mr,Kiii1.
-7-ci ':;PCN
.E.
21 mvim..
CRE tCO2.18-33.
REF. RANGE
Hb*.
13 g/t11.
A
G
*via Hct 3.3-5.5 g/dI
C -immisimg.INST GC: OK.O1
----CHEM GC: O
pH
7.381 T ' . 26-84 u/1
111111mIlmi HEM 0 LIP 0.
ICE 0.
?., ,.
PCO2..
36.2 mmHg
• 1313 4
TEST 401,''''
HCO3.
21 mmol/L
BEecf
-4 mmol/L 11-38 till
GLU
0.2-1.6m0
Sample Type_: BUN
5-65 u/1
CRE
255EP03.
21:05
S.4-8.101
CK
Oper: IIIIN(L\
t
V7-NA+
Physician:_
EF. RANGE
K
5er# 1111.
.... 128-145 mmolil
CL
tCO2 18-33 mmol/1
o1/1 3.3-4.7 mmoUl
98-108 mmol/1
tCO2 18-33 romolfl
REMARKS:
REPORTED BY: DATE: LAB ID NO.:
MEDCOM 20073
-
DOD-033647
Ward/Section: REQUESTI G PHY5ICAN:
CHEMISTRY RESULT FORM
ico 3 0)(G) (Subject to the Privacy Act of 1974) SSN/PSEUDO SSN:
N 138-146 mmol/dL ALB 3.5-5.5 g/d1
73-118 ing/dI
GLU
I
K 3.54.9 mmol/L
7-22 mg/di
BUN
98-109 mmol/L
CA -1 + 8.0-10.3 Ing/d1
------- PICCOLO --------
pH 7.31-7.45
09/23/03.CRE 0.6-1.2 mg/d1
04:39 PM
PCO2 35-45 mmHg (art)
REFERENCE RANGE:.NA 128-145 nmol/d1
MALE
41-51 mmHg (yen)
PATIENT #:,1111, (0(6)-Li
P02 80-105 nunllg (art)
N/A (ven) K 3.3-4.7 mmo1/1
METLYTE 8
TCO2 23-27 mmol/L (art)
DISC LOT #: 3141AA4 CL
24-29 mmol/L (yen) 98-108 =nail 22-26 mmol/L (art) OPER #. DR #: 000
HCO3 23-28 mmol/L art tCO2 1S-33 mmol./1
SERIAL
SO2
95-98% 00)-1-pato! 004:4 BEcef (-2) (+3) GLU 127* 73-118 MG/DL
nunol/L TEST "E RANGE RESULT
BUN m 7-22 MG/DL
AnGap 10-20 timid& ALB
3.3-5.5 g/d1
Ca CRC 0.6 0.6-1.2 MG/DL
1.12-1.32 narnol/L
CK 556* 39-380 U/L ALP 26-84 u/I
BUN 8-26 mg/dl
NA+. M 128-145 MMOVL ALT 10-47 WI
GLU 70-105 ing/dI K+ 3.8 3.3-4.7 MMOVL
AST 14-97 u/I
CL-106 98-108 MMO.fiL
Creat 0.7-1.5 mg/dl tCO2 22 18-33 MOLL
AMY 11-38 u/1
Het 38-51% PCV
TBIL 0.2-1.6 mg/t11
INST OC: OK.
CHEM QC: OK
Hgb 12-17 g/d1 HEM 0 , LIP 0 , ICT 0 GGT 5-65 u/1
T"..S-71"e-tk TP 6.4-8.1 g/d1
TEST RESULT REF RANGE tarY-ar
601
.0.
Tropoin-1 !'EST RESULT REF: RANGE
A74 314
Drug of
iA+ 128-145 turno1/1
Abuse
3.3-4.7 nuno1/1
98-108 mmol/1
CO2
18-33 mmoUl
REMARKS:
REPORTED BY:
fob DATE:
LAB ID NO.:
MEDCOM - 20074
DOD-033648
Ward/Scctio • .....),, 17QUES . ' •
(46)-2--
DATE MLAST, FIRS7MI ... .
iiiii.._
(b 01 •
oP: N :1" i'17: , ;1541 I P t ' . zftk „ 1 , , ra , ,
Old t
.e :A A ' A ..4% .0 40 L'4. . ' 2*-':"I'A ' *'' '-'""'.!' , ,e',:ft'l ''.'
TEST RESULT REF RANGE TEST RESULT REF RANGE Na 138-146 mmol/dL ALB 3.5-5.5 g/d1
K 3.5-4.9 mmol/L ALP 26-84 u/1
CI 98-109 nunot/L ALT 10-47 WI
A MV
pH 7.31-7.45 '4 07 ..n
PCO2 35-45 mmHg (ar
41-51 mmHg (ve
, 80-105 mmHg (al
P02 PICCOLO
N/A (yen)
23/09/03 11:02
23-27 nunoUL (a;
TCO2
24-29 nunot/L (vi REFERENT RANGE :
f MALE
22-26 mrnol/L (a]
HCO3 PAT I ENT te :11pi U-4(1)-1
23-28 nation (at
METLYTE 8
SO2 95-98%
DISC LOT # • 3141AA4
BEecf (-2) - 0-3)
y nnuon, OPER # : irai DR #: 000 An Gap 10-20 nunol/L SER I:f 1__Millir Ca 1.12-1.32 nimolll • ..• qD1(. 01.-BUN 8-26 mg/di GLU 104 73-118 MG/DL zBUN 4* 7-22 MG/DL
GLU 70-105 mg/dl
CRE 0.5* 0.6-1.2 MG/DLCK 703* 39-380 U/L
Creat 0.7-1S mg/d1
NA -E 123* 128-145 NIMOV1_
Hct 38_51% PCV K+ 3.3-4.7.
3,8 MMOi/L CL 105 98-108 MMOVL
Hgb 12-17 g/d1
tCO2 21 18-33 MMO&1_
Fril* ' i7.7711ii .
:n
TEST RESULT REF. RANGE I NST GC: OK CI-EM QC: OK l hEM 0 , LIP 0 , ICT 0
Tropoin-1
Drug of Abuse
REMARKS:
)(6) REPORTED BY: 401/DATE: LAB ID NO.:
CHEMISTRY RESULT FORM
(Subject to the Privacy Act of 1974) SSN/PSEUDO SSN:
'•:., ,...:5,7i :4411,
'k". *3 /''. = .,,A ,,WC.X ' ler '.4'l'
TEST RESULT REF RANGE
73-118 mg/di
GLU
7-22 mg/dl
BUN 8.0-10.3 mg/dl
CA ++
CRE
0.6-1.2 mg/di 128-145 mmol/d1
NA+ K+ 3.3-4.7 mmol/) CL7 98408 nuno1/1 18-33 mmol/1
tCO2
.....ape"
Ail IttMliiiit' c
TEST RESULT REF: RANGE
ALB 3.3-5.5 g/d1
ALP 26-84 WI
ALT 10-47 WI
AST 14-97 u/1
11-38 u/1
AMY
'OIL 0.2-1.6 mg/111
GGT 5-65 u4
TP 6.4-8.1 g/d1
. ,
''..-14., '1t A .,v
g,,. ,,-; l'' . -, *1. -.* -
TEST RESULT REF RANGE
NA+ 128-145 mmol/1 K+ 3.3-4.7 mmol/1 CL--98-108 mmol/1 tCO2 18-33 mmol/1
MEDCOM - 20075
DOD-033649
Wartl/SectionT-L, REQUESTING PHYSICAN:
LAST, FIRST,
0(6)
D
TEST RESULT
WBC
RBC
Hgb
Hct
3
MCV 80
81Pit 130-
verified
20.5-51.1°
Segs
Bands
Lymph
Atyp
RBC
Morph
Spun
Hematocrit
Set Rate
Other
TEST RESULT REE RANGE IT
PT 9.8-13.6 secs
APTT 21.34 SESS
D dimer 20 ug/m1
FDP 10ug /
REMARKS:
REPORTED BY: DATE:
LABORATORY RESULT FORM (Subject to the Privacy Act of 1974)
T 1\ E SSN/PEEUDO SSN:
st
•X...-r14,-
•.
4 ••
REE RANGE
Negative Negative
Source
Grant
Stain
Occ Bid ; Negative
H. pylori Negative
MUST SUBMIT SF 518 WITH
EVERY UNIT REQUESTED
ABO/Rh
TYPE CROSSMATCH
N
LAB ID NO.:
MEDCOM - 20076
DOD-033650
46/
Ward/Section: RE ICAN• )(L..4____
*;;:"
CHEMISTRY RESULT FORM
. (Subject to the Privacy Act of 1974)
.]:(1 ,:....) DATE TIME SSN EEUDO S •
LAST, FIRST,MI.
40-q'a.2b cc
2" px,, equ trj. 12jli:in;.,,,. trg ' '
' ,*°: :1.,...' , ;AU : ., ...: ' -API ', 04-4-Vtagoi:tV't -0 ....k,,,AA.:tek:%,:&‘ :•''' ._ o,
TEST ESU REE RANGE TEST "RESULT . REE TEST RESULT REE RANGE RANGE
2 4_c c .thil
. 138-146 nonol/d1 ALP 73-118 mg/d1
-TU —
ALI 7-22 trig/d1
IN
.: AL' PICCOLO L -I-+ 8.0-10.3 ing/d123/09/03 0904
1 i-STAT G3+
0.6-1.2 mg/dl
AM REFERENCE RANGE: mALE ZE Pt VOL AS PATIENT Th"al.(6y6) I 1+ 128-145 mmo lAll METLYTE 8
--I.Pt Home; TB 334.7 mmo1/1
DISC LOT #:
- 3141AA4 1 BI OPER # : 98-108 nonol/1
: 000 '
_
— TCO2 25 mmul/L JAL Pit _
I C., 02 18-33 inmo1/1
1---
• .0
At 37C
CI GLU 113 73-118
MG/DL PIA i*";1"riC.:!:',"*4:::::
pH 7.379
7 BUN 6* 7-22 MG/DL :ST RESULT REE RANG PCO2 39.9 mmHg — CRE 0.6 0.6-1.2 MG/ DL
A G B 3.3-5.5 g/dI
— P02 --77 mr4H9 CK 743* 39-380 U/L
T. e 26-84 u/I
NA+ 126* 128-145
— HCO3 24 mmul/L MMUL
.T 1047 u/I
, K+ 3.4 3.3-4.7 MMOVL
— 8Eecf -2 mmol/L
• CL- 103
98-108 MMOVL a 14-91&1
502* 95 %
' t002 21 18-33 MMOIL
*calculated
11Y 11-38 WI
_
--MIST OC: OK CHEM GC: OK
BIL 0.2-1.6 mg/ill _ Sample Type_: — B"I-EM 0 ,.
LI P 0 , ICT 0 C GT S45ull
235EP03. P 6.4-8.1 g/dI
09:04
Oper: Ill (b)
EST RESULT REF. RANGE
T Physician:
Ser*8 itit,,,.., A+ 128-145 mmolfi
,,,,_..,
,.,
3.3-4.7 Inmo1/1 _ ;el-1 98-108 mmol/1
I tCO2 18-33 nunoln
REMARKS:
REPORTED BY: DATE: LAB ID NO.:
(4)(0 --Lt
MEDCOM - 20077
DOD-033651
Ward/Section: Jo 3 REQUESTIN LABORATORY RESULT FORM
(Subject to the Privacy Act of 1974)
LAST, FIRST,M1. CV-
DATE TI L...130 S
J SSN/PEE1
LI
TEST RESULT GE TEST RESULT REF. RANGE TEST REF RANGE
VIII:tr' 4 0 *00 ..•11
Color N/A RPR
Negative
App N/A Mono Negative Glu Negative
41"
Bili Negative Source
Ket Negative Grant Stain
SG Nhr Occ Bid Negative
Bid Negative B. pylori Negative
-LI
N/A
p Men
1123-09-03
Parasites
08:24.11 Patient Prot Negative Malaria Limits WIC 15.4 H i10"3/eL 4.5 10.5 Urob 0.2-1.0 0& P -RBC 4.57 x101/aL 4.00 6.00
HO 11.7 g/di. 11.0 18.0 Nit Negative Other -Hct 36.0 2 35.0 60.0
Leult. Negative
ID 80.6 ft 80.099.? -11CH 25.5 L p9 27.0 31.0
} roe 31.7 1 g/c11. 33.0 37.0 HCG Negative
Pit 224. 101/11. 150. 450.
LY2 9.9 *1. 20.5 51.1
CM 1.5 * s10"3/td. 1.2 3.4
7141‘1
A A. .11
Cell
MUST SUBMIT SF 518 WITH
Count
EVERY UNIT REQUESTED
Directigen Negative ABO/Rh
TEST RESULT REF RANGE UNIT
TYPE CROSSMATCH
PT 9.8-13.6 secs
APTT 21.34 SESS
D dimer 20 ug/ml
FDP 10 ug /m1
REMARKS:
REPORTED BY: DATE: LAB ID NO.:
MEDCOM -20078
DOD-033652
CAN:
(.0
TEST RE
olor
_- ----- PICCOLO .
PP
04:46
REFERENCE RANGE:.
23/09/03.U
MALE
coJ4 Bill
PATI ENT # :.] METLY TE 8 Ket
DISC LOT #:.
3141AA4
SG
DR #: 000
OPER #: .
Bld
SER I AL : 14111=1,
pR
106 ' 73-118 MG/DL
5* 7-22.
(LU.
MG/DL
BUN.Prot
CRE.
0.4* 0.6-1.2 MG/DL
REE RANGE
N/A
N/A Negative
Negative Source
Gram Stain N/A Occ Bld
Negative H. pylori Negative
N/A Micro Parasites
Negative Malaria
741*„35-380.Urob 0.2-1.0 NA+.
CK.U/L
1.21_28-145 MOM_
Nit Negative
3.5 3.3-4.7 MMOVL
K*.
Negative
103 98-108 MMOVL
18-33.
CL-.
tCO2 21.MMOVL Negative
CHEM QC: OK Fat 0 e LIP 0 ICT 0
INST QC: OK.
LABORATORY RESULT FORM
4-4-(Subject to the Privacy Act of 1974)
REF RANGE
Negative
Negative e $ 00$4,10:
"t
Negative
Negative
MUST SUBMIT SF 518 WITH
00) (Th Cell
Count
EVERY UNIT REQUESTED
23-09-03
0II) 1111111P.
04:48 Directigen ABO/Rh
Patient
Limits
WC 14.111 x1003/uL 4.5 10.5
RPC 4.48 110"6/s1 4.00 6.00
NO 11.4 g/d1. 11.0 18.0
Net 36.3 2 35.0 60.0
•
80.9 ft 80.0 99.9
•
25.4 L pg 27.0 31.0 RCM 31.4 L gitfl. 33.0 37.0 Pit 236. x1011/uL 150. 450.
A LYZ 9.8 *L 2 20.5 51.1 LYP 1.4 * 110"3/et 1.2 3.4
UNIT TYPE
MEDCOM - 20079
DOD-033653
LABORATORY RESULT FORM
(Subject to the Privacy Act of 1974)
SSN/PEEUDO SSN:
TEST RESULT REF RANGE REF. RANGE TEST REF: RANGE
WT Color RPR Negative
RI PP N/A Mono Negative
114 = = : : PICCOLO = =7:: - :'=."Fr
u Negative
Ek 2309/03.
00 :17
Bili Negative Source
MALE
W PAT I ENT # :MIMINVOIH, Ket Negative Gram
RE .F LRE.NCE RANGE :.
Stain
pft BASIC METABOLIC
SG Occ Bid Negative
3145AA4
Ly' OPER # : DR C 0 31d Negative 11. pylori Negative
SERIAL #:.oli Micro
DISC LOT #:.
•.Parasites
611)1.(.9
Sq GLU 108 73-118 MG/DL Negative Malaria
BUN.MG/DL
5* 7-22.
CA++ 9.0.
8.0-10.3 MG/DL 0.2-1.0 O&P
Lyn CRE.0.6-1.2 MG/OL Negative
0.7
Other
128 128-145 MMOVL
NA+.
Ady Negative
3.8 3.3-4.7 MMOVL
CL-.Negative
K+.
103 98-108 MMOVL
t CO2 20 18-33.
MOM_
Mtn
MUST SUBMIT SF 518 WITH EVERY UNIT REQUESTED
4)-1
.Negative ABO/Rh
23-09-03
PE_ 00:19
Patient
Limits
WC 15.1 H x10"3/5L 4.5 10.5
RE 4.70 x10 6/d. 4.00 6.00
TES i 12.3 g/d. 11.0 18.0
CROSSMATCH
Ha 38.1 Z 35.0 60.0 PT IV) 81.0 fl. 80.0 99.9
11:11 26.21. PI 27.0 31.0 BIC 32.3 L gni. 33.0 37.0 APT') x1013/51. 150. 450.
Pit 237..
Lii 10.6 44. I 20.5 51.1 D dim LII 1.6 • :101/51. 1.2 3.4
MEDCOM - 20080
DOD-033654
PHtlo LABORATORY RESULT FORM
(Subject to the Privacy Act of 1974)
N(1)--Li DATE TIME 3 Do SSNIPEEUDO SSN:
TEST GE
WBC 4.8-10.8 x1(
R H DIIIIIi(6)(6)-Lk 23-09-03 2 2:08
Patient
' Lisits
I'f t_• CBC 16.6 H x10 .3/tE 4. J 10.5
TX 4.99 x10"6/ul 4.00 6.00 1196 12.4 9/dL 11.0 18.0 L. tict 40.3 Z 35.0 60.0
XV 80.8 fL 80.0 99.9 0 24.9 L pg 27.0 31.0
...,?, trilE 30.9 L 9AL 33.0 37.0
Plt 23?. x10'3/uL 150. 450.
La 5.6 *L Z 20.5 51.1
LII: 0.9 * x10"3/uL 1.2 3.4
TEST
PT
APTT
D dimer
FDP
REMARKS:
REPORTED BY: DATE: LAB ID NO.:
MEDCOM - 20081
DOD-033655
Ward/Section: REQUESTING PHYSICAN:
CHEMISTRY RESULT FORM (Subject to the Privacy Act of 1974) DATE TIME SSN/PSEUDO SSN:
LAST, FIRST,MI.
. ,, ar-,4 4.„...„,.24%' ,: 40:
it A'-ii i6v, ',NT. -' .!.: .7, 4 ,agot, v,
t 4. 0,,, ,„:rttAlAt ,.. 'XS kg.3. ,/ ' k'.,. 4-,-+..? _ itiz 'flyer 44,4„,„,... _ jk: 53 r
72,..4e0, ,..,,
TEST RESULT REE RANGE TEST RESULT REE TEST RESULT REE RANGE RANGE
Na 138-146 nunolldL ALB 3.5-5.5 g/dl 73-118 mg/dl
GLU
K 3.5-4.9 mmol/L ALP 26-84 till 7-22 mg/ill
BUN
i CI 98-109 nunol/L ALT 10-47 u/1 CA++ 8.0-10.3 mg/d1
pH 7.31-7.45 AMY 14-97 u/I 0.6-1.2 mg/dl
CRE PCO2 35-45 mmHg (art) AST 11-38 u/1 128-145 mmol/dl
NA
41-51 mmHg (ven) P02 80-105 mmHg (art) TBIL 0.2-1.6 mg/dl K+ 3.3-4.7 mmol/1N/A (ven) TCO2 23-27 mmoUL (art) BUN 7-22 mg/d1 Ci: 98-108 mmol/l
24-29 mmol/L (ven)
HCO3 22-26 mmol/L (art) CA++ 8.0-10.3 mg/d1 18-33 mmo1/1
tCO2
23-28 mmol/L (art)
SO2 95-98% C
' 1 Dettt
104,1,',--
—
BEecf (-2) - (+3) C ?ST RESULT REF. RANGE
nunol/L
7=:.::::: PICCOLO -'7
AnGap 10-20 mmoULC 3.3-5.5 g/dI
mmoUL .B
24/09/03 00:5
9
Ca 1.12-1.32 nunol/L IRLFERENcE RANGE . X 26-84 u/I
MALE
BUN 8-26 mg/dl PATIENT # ;((,, ,T 10-47 WI
_1
-.1L'• METL
GLU 70-105 mg/d1 — sT 14-97 u/1
DISC YYLL OT 8
OT #:
3024AA4
Creat 0.7-1.5 ing/ d1 OPER #: DR #: 000 MY 11-38 WI
C SERI
)- 1111111W
Hct 38-51% PCV B1L 0.2-1.6 mg/dl
1 ... )
Hgb 12-17 g/d1 c a_u , 120* 73-118 MG/DL 54510
GT Ae-r BUN MG/OL P 64-al g/d1 ye w. a .s...r ,.. . o4, , ..:‘,.. 1 CRE
0 . 6 0.6-1.2 MG/DL
TEST RESULT REF RANGE 1' CK"4iet:" co10 .7,,i
331 39-380 U/ L
NA+ .'"S" .10 r,,,.,0
• # # /37123-145
MMOI/L EsT RESULT REE RANGE
Tropoin-1 rii., — — I .K+ 3.6 3.3-4.7
----e
11101/1_
CL-
Drug of ( 103 98-108 MMOPL A+ 128-145 mmol/1
Abuse t002 24 18-33
MMOM_
( • 3.3-4.7 mmoUl INST OC: OK
C1- E1 OC: OK HEM 0 ) LIP 0 , ICT 0 -98-108 nuno1/1
:02 18-33 mmo1/1
REMARKS:
REPORTED BY:
MEDCOM - 20082
DOD-033656
LABORATORY RESULT FORM
(Subject to the Privacy Act of 1974)
1P.
24-09-03 tiN .00:58 Patient
Litaits-SO 14.8 H x1063/d 4.5 10.5 RRC 4.68 x10'6iii 4.00 6.00 ligli 11.9 gidL 11.0 18.0
35.0 60.0 CV 81.6 ft. 90.0 99.9 1104 25.5 L Pg 27.0 31.0 PDC 31.2 L g/dL 33.0 37.0 Pit 224. 110A3/ti. 150. 450.
07. 4.4 *t. x 20.5 51.1 LY# 0.7 * x10'3/111 1.2 3.4
"N.4+ -es:m
MEDCOM - 20083
•-¦••••"."--
DOD-033657
Ward/Section: REQUESTING . PHYSICAN: CHEMISTRY RESULT FORM (Subject to the Privacy Act of 1974)
DATE TIME SSN/PEEUDO SSN:
LAST, FIRST,MI.
401(44114.m.
NW"
•
TEST RESULT REE RANGE TEST RESULT REE TEST RESULT REE RANGE
RANGE
138-146 mmoVdL ALB 3.5-5.5 g/dl 73-118 mg/dl
Na GLU
3.5-4.9 mmol/L 7-22 mg/dl
K ALP
CI 98-109 nunoUL ALT z-" 8.0-10.3 mg/di
===
PICCOLO
24/09/03
pH 7.31-7.45 AMY --=:='' 0.6-1.2 Ing/d1
REFERENCE
04:50"
PCO2 _AST RANG E:" 128-145 mmol/dl
34551 mmHg (ven) PAT TENT # :
145 mmHg (art) "MALE —
METLYTE 8
P02 80-105 mmHg (art) TBIL I (6)(9.4/ 3.3-4.7 num
NIA (yen)
DISC LOT #: —.
TC 02 23-21 mmol/L (art) BUN 98108 rnmo1/1
24-29 mmol/L (yen) °PER
11: 31 5?Am
22-26 mmol/L (art) SERIAL #: 18-33 nuno1/1
HCO3 CA Mr CR # : 000. 2
23-28 mmol/L (art)
SO2 95-98% CH ...... . ,
w... 15100%1X0 41C, t
GLU 137 ... .,...s ,,-=x$:
BEeci (-2) -(+3) CF BUN "73-118 • ;T? * REE RANGE
mmol/L 1104 / RESULT
af7 7-22"hiG0L RA'
CRE 0
AnGap .f3.3-5.5 g/d1
10-20 mmoUL 8.
0.6-1.
CK 280
friG/DL
Ca 1.12-1.32 nunol/L T NA + 2 mu/oL 26-84 u/I
38-P3
74K+ -. 38°
BUN 8-26 mg/d1 ".h4 10-47 u/I
2B-145 U/I- 'T
ril 3.8.
NMOtt_
70-105 mg/dl CL 3.3-4.7.sT 14-97 u/I
GLU 11,10/4_
CL-05 88-108
tCO2 22 18-33 MMOtL .
.
Creat 0.7-1.5 mg/d1 tMY 11-38 u/I
10t/L
f INST OC. 0/(.
Hct 38-51% PCV TBIL 0.2-1.6 mg/d1
.WM 0 , ChEM.
OC'
LIP 0 OK
Hgb 12-17 011 GOT 5-65 u/I
, ICT 0
TP
TEST RESULT REE RANGE
Tropoin-1 Drug of NA+ 128-145 mmot/1
Abuse K+ 3.3-4.7 nintolll
98-108 mmol/1
tCO2 18-33 mmol/1
REMARKS:
REPORTED BY: DATE: LAB ID NO.:
MEDCOM -20084
DOD-033658
RiiiipsicArN(61 2_
LABORATORY RESULT FORM
(Subject to the Privacy Act of 1974)
7'5
YPe
:'45F.P3:1
y57,
.5,,r :.;: •
AI
04148
tfir
Patient Limits 143 H ;10'3/IL 4.5 10.5
EC PE 4,78 x10'6./i11 4.00 6.00
11.0 18.0
14 12.2 gidL Itt 39.3 % 35.0 60.0 CV 82.2
-1 00.0 79.9 NCH 25.6 1 pg
27.0 31.0
riX 31.1 L g/dL 310 37.0 Pit 226, x10'3PIL 150. 450.
IV. 4.3 *I. % 20.5 51.1 LY# 0.6 t x10'3fuL 1.2 3.4
REPORTED BY:
Bili Ket SG Bld pH
Prot
Urob Nit Leak
1)
7E
DATE:
DATE TIME SSN/PEEIJDO SSN:
RESULT REE RANGE REE RANGE
N/A RPR Negative
N/A Mono Negative
Negative Source
Gram Stain N/A Occ Bid Negative
Negative Negative Negative
II. pylori
N/A Micro
Parasites
Negative Malaria
0.2-1.0 O&P Negative Other j Negative
010.001#
,;;SWAti `v
;74
MUST SUBMIT SF 518 WITH EVERY UNIT REQUESTED
UNIT TYPE CROSSMATCH
LAB ID NO.:
MEDCOM - 20085
DOD-033659
TER() q-‘? (
Ward/Section: REQUESTING PHYSICAN:
CHEMISTRY RESULT FORM (Subject to the Privacy Act of 1974)
DAT TIME SSN/PEEUDO SSN:
LAST, FIR
9,, Gib
;E RESULT REF RANGE
dL 3.5-5.5 g/d1 73-118 mg/di ** PRINT•CANCELLED ** 7-22 mg/dl
BUN
8.0-10.3 mg/d1
CA ++
====:== PICCOLO CRE 0.6-1.2 mg/di (art) 09/24/03.
09:19 AM 128-145 mmolldl
NA+
i — STAT G3+ (ven)
REFERENCE RANGE: , , MALE
; (art)
3.3-4.7 mmol/1
PATIENT #:
Pt: @815
, (art) METLYTE 8.CL
98-108 mmol/1
Pt NaMe: (yen)
DISC LOT #:
, (art) 3141AA4
18-33 mmol/1
art DR #: 806
TCO2 20
mmol/L
RESULT REF RANGE
At'37C
GLU 132* 73-118 MG/DL
PH..L 3.3-5.5 gill
7.358
BUN 0t, 7-22 MG/DL
PCO2.26-84 u/I
33.6 mmHg CRE 0.8 0.6-1.2 MG/DL
P02.68 mmHg CK 140 39-380 U/L 10-47 u/I
NA+ 124* 128-145 MOM__
HCO3.19 mmol/L . 14-97 u/I
K+ 3.5 3.3-4.7 MOW
BEed.
—7 mmol/L
CL- 109* 98-108 MOM_
s02*.93 11-38 u/I
tCO2 26 18-33 MMOVL
*calculated
TBIL 0.2-1.6 mg/d1
INST OC: OK.
CHEM OC: OK.
GGT
Aratient Temp HEM 0 I LIP 0 , ICT 0
6.4-8.1 01
.
7.354
iE
PCO2.
34.0 mmHg
P02.S5 mmHg RESULT REE RANGE Patient Temp: 99.1F
128-145 mmol/I
F102 .
: 70 Sample Type_: 3.3-4.7 mmoUl
98-108 trunolll
18-33 mmoUl
REPORTED BY:
DATE: LAB ID NO.:
7
MEDCOM - 20086
DOD-033660
LABORATORY RESULT FORM Ward/Section: cu (Subject to the Privacy Act of 1974)
SSN/PEEUDO SSN:
406%V. VV1W47 X.
4..
"1:k6ais, "WSW4*#
RANGE TEST RESULT REF. RANGE TEST
RESULT
TEST
Ly
Al
RI
dit.Ineyth
24-09-03 Wit 0'817 Patient
Limits At 14.5 3 x10'3/eL 4:5 10.5 Ri 4.60 x1061e.L 4.0a 6.(X) HO 7 1dL 11.0 18.0 Ht 37.8 Z 35.0 60.0 MI i2.1 fL a0.0 99.9 ?EH 25.4 L PS 27.0 3L0 ttfE 30.9 L•g/dL
33,0 37.0 Fit 219. t10' 1513. 450. LYZ 5.0 *4_ Z 20.5 51.1 Litt 0.7 *1.. x10."31lli 1.2 3.4
REF RANGE
9.8-13.6 secs
21-34 SESS
D dimer 20 ug/ml 10 ug /ml
REPORTED BY: REMARKS:
Color N/A RPR
PP N/A Mono
Negative
Bili Negative Source
Ket Negative Grain Stain
SG Oct Bld
Bld Negative II. pylori
pH Micro Parasites
Prot Negative Malaria
Urob 0.2-1.0 0 & P
Nit Negative Other
Leuk Negative
HCG Negative
•
REE RANGE
Negative Negative 4,..45x,:t • '
Negative Negative
3teim;:a„
MUST SUBMIT SF 518 WITH
Cell Count EVERY UNIT REQUESTED
Directigen Negative
•
CROSSMATCH
UNIT
DATE: LAB ID NO.:
MEDCOM 20087
-
DOD-033661
Ward/Sectr u REQUEMINICANvi
CHEMISTRY RESULT FORM
(Subject to the Privacy Act of 1974) TIME SSN
LAST, FIRST,MI. EeLd
b) (G)-
200
-,e4MftRWsW,,
TEST RESULT REE"TEST RESULT REF RANGE
RANGE
ALB 3.5.5.5 g/dl
GLU
BUN
CA ÷±
------- PICCOLO ______ -
CRE
09/24/03.
11:54 AM
128-145 nunol/d1
REFERENCE RANGE: li.NA+
MALE
PATIENT #:41111,N(c)-Lf
I K 33-4.7 mmoUl
METLYTE 8
'1 CL 98-108 mmo1/1
DISC LOT #:.
3141AA1 OPER #'.ICO2 18-33 mmol/1
I DR #: 000.
SERI
5
GLU 138* 73-118 MG/DL A BUN ••s 7-22 MG/DL CRE 0.6 0.6-1.2 MG/DL
C
CK 185 39-380 U/L
I
NA+ 121* 128-145 MMOM_
aka if Net' TEST RESULT REE RANGE
ALB 3.3-5.5 g/d1
ALP
ALT
K+.AST
3.5 3.3-4.7 MMOM..
CL-.
111* 98-108 MMOM_ tCO2 23 18-33.AMY
MMOVL
73-118 mg/dl
7-22 mg/c11
8.0-10.3 mg/d1
0.6-1.2 mg/d1
26-84 ufl
10-47 u/1
14-97 u/1
11-38 u/1
I TBIL GGT INST QC: OK.CHEM QC: OK HEM 0 , LIP 0 , ICT 0 0.2-1.6 mg/dl 5-65 u/1
1 ,7.rnp; TP 6.4-8.1 g/d1
FO
TEST RESULT REF RANGE
C(G)--1- NA+ 128-145 mmoUl 3.3-4.7 mmoUl
CL 98-108 mmol/1
tCO2 18-33 tranolil
REPORTED BY: ( bl(P Z- DATE: LAB ID NO.:
r2L
MEDCOM - 20088
DOD-033662
1.
-
-FC D2-- bOa(0
I LABORATORY RESULT FORM
(bject to the Privacy Act of 1974)
71-09-03
\3
t
Lipits
IBC 14.0 H , mr.
4.5 10.5
RIC 4.40.
xiTilti 4.00 6.00
m 11.1.11.0 18.0
R:t 35.3.30 60.0
ncv 81.4 90 9?.9
fL.
MCH 25.3 L pg.
27.0 31.0
ICHS 31.0 L gAL.
33.0 37;0
Plt 159..
x10/ui 150. 450.
La 4.9 *t.
20.5 51.1
0.7 4.: xlee3lul..
IA.1.2 3:4
REMARKS:
LAB ID NO.:
MEDCOM 20089
-
CROSSMATCH
DOD-033663
Ward/Section: REQUESTING PHYSI CAN: CHEMISTRY RESULT FORM
(Subject to the Privacy Act of 1974)
SSN/PEEUDO SSN:
LAST, Fl
T T RESULT .ReINGE RESULT REF REE RANGE
••• RANGE
ALB 3.5-5.5 g/d1 73-118 mg/(11
7-22 mg/d1
i-STAT EG.--- --- PICCOLO == ---- 8.0-10.3 mg/dl
0 Pi 01_ 15:-58
1 Pt: 111/.24/09/03.MALE 0.6-1.2 mg/di
REFERENCE RANGE:
1 Pt mame : V,t_aW (101),)-128-145 mmol/dl
PATIENT #: MEFLYTE 8 3.3-4.7 mmol/1 Ma _145 mmoi/L -Disc LOT #: 3141AA4
98-108 mmol/1
DR #: 000
OPER #:.
_2.7 mmol/L.
mmol/L
i Ca 1• ,cfica/L
Hct 3G %ACV Hb* 10 9/dL *via Hct
At 37C
SERIAL 18-33 mmol/1
GLU 130* 73-118 MG/DL
BUN 441 7-22.TEST RESULT
MG/DL
CRE 0.6 0.6-1.2 MG/DL ALB
3.3-5.5 g/dl
CK.U/L
161 39-380.
ALP 26-84 u/1
, NA+ •ff 128-145 MMOL'L
ALT 10-47 u/1
K+.3.3 3.3-4.7 .MMO&L
pH 7.335.CL-.14-97 u/1110* 98-108 MMUL AST tCO2 23 18-33 rpm
PCO2 35.8 mmHg
AMY 11-38 u/1
P02 95 mmHg
CHEM OC: OK
INST DC: OK.
19 mmol/L
HCO3.
HEM 0 , LIP 0 r
BEecf.
-7 mmol/L
502* 97
7 - S kf4.
*calculated
At Pat ient Temp
Ai a .-
7.33;
pH.
PCO2 35.8 mmHg
95 mmHg
PO2.
Patient Ti.mp: 98.6E Sample TyFe_:
15:38.
._00)0_7,
24SEP03 ..
Oper:1111
Physician:7/.
DATE: serif MI ver: IIIIIIII1
TB11., 0.2-1.6 mg/d1
ICT 0
GGT 5-65 u/1 6.4-8.1 g/dl
EST RESULT REF. RANGE
in 128-145 mrno1/1 3.3-4.7 rnmo1/1
98-108 mmol/1
CO2 18-33 nuno1/1
LAB ID NO.:
MEDCOM - 20090
DOD-033664
SULT
N(G)-ki
ry
NP1 15:42 Pa-jent
Ll P14:5
121:.15.1 .121 410'111L.4,5 10.5 RIC 4.46.;1(rt/vL 4.00 'a HO.11.5.;id:..1:.C. 18.0 Ht 36.6.1.35.0 60.0 iCV 132.1.30.0 W.9 fiDi 25.8 L P9.
27.0 31.0
rIDE 31.4 L cildL.33.0 37.0 Plt 204..:10'3/ut 153. 450. LI% 3.5 *I.1.20.5 51.1
Ltd.5.Y14t3leL.1.: 3.4
LABORATORY RESULT FORM
(Subject to the Privacy Act of 1974)
REE RANGE
ItmANtn4.
CROSSMATCH
REMARKS:
REPORTED BY: DATE: LAB ID NO.:
MEDCOM - 20091
DOD-033665
Ward/Seclion: REQUESTING PHY SI CAN:
CHEMISTRY RESULT FORM
(Subject to the Privacy Act of 1974) LAST, FIRST,MI. DATE TIME SSN/PEEUDO SSN:
"
' '
opt tsamw N•--. f . Items..me f ti
410-4: a4 e.
NI:U •K.WM:;AW" '& 4 ::1.t .'1',1'
TEST RESULT REF. RANGE
138-146 nunoUdL
Na
K., 3.5-4.9 nurton
98-109 mmoUL
pH 7.31-7.45
PCO2 35-45 nunllg (art)41-51 mmHg(yen)
P02 80-105 mmHg (art)N/A (ven)
TCO2
23-27 mmol/L (art)24-29 mmol/L (ven) HCO3 22-26 mmol/L (art) 23-28 mmon (art) SO2 95-98%
BEecf (-2) - (+3)
mmot/L
AnGap 10-20 mmol/L
Ca 1.12-1.32 nunon
BUN 8-26 mg/d1
GLU 70-105 mg/dl
Creat 0.7-1.5 mg/d1
Het 38-51% PCV
Hgb 12-17 g/d1
:
1%7 .• . " .
TEST RESULT REF RANGE
Tropoin-1
Drug of Abuse
.
REMARKS:
REPORTED BY: (bk
111111111i
TEST
ALB
3 ''''.•
,,,,,,,,
., -.-A , ,, t-Ir.birri
,. - !..'
'''':1# -,.
, M m wf ' v aitatx,MgdP
w ' '11.
RESULT REF TEST RESULT REF RANGE
RANGE
3.5-5.5 Wdl GLU I .
BUN [._.
- - - - — PICCOLO . 09/24/03.
08:54 PM.. REFERENCE RANGE :.
MALE . i -ST A T EC8+
PATIENT #: Milli (b) qt) ti..METLYTE 8
73-118 mg/c11 7-22 mg/dl ------ ---
Pt. : a 1 . -
DISC LOT # :.
3141 AA4
opER #:.
Pt Name:
DR #: 000. -
SERIAL 1111
(4q z.
17:
Glu1133 mg/dL.
GLU.138*.73-118.MG/DL.
BUN 13 mg/dL
BUN.ff..7-22.MG/DL -
ma____.
CRE.0.6.0.6-1.2.MG/DL. K .*:.:* mmol/L
CK.39-380.U/L.
+..117*.28-145.Cl .116 mmol /L
MMOL.K+.3.6.3.3-4.7.MMOVL.TCO2 .23 mmoi/L a...- 11 1* 98-108.MM014_.reap .*** mmol/L
tCO2.111.18-33.
M_
MMOL'L.
' 4,11; 40 :PCV -
ib* 14 g/d1.1
INST OC:.OK.CHEM OC: OK.,. HEM 0.,.LIP 0.ICT 0.*via Hct. -
,.
.
PH.
7.3'20
PCO2 41.8 mat-109
HCO3.
-122 mmoi/L
i.sl-c- A .1---___. •
Veci .
_75mmol/L t--0 re CA'Nk_ (._\__ afte.90gPti:
-
20:41.
..
Sc) &,....A...“..\ ---2
K+ 3.3-4.7 mmolA
CL- 98-108 mmoUl
tCO2 18-33 mmo1/1 i
DATE: LAB ID NO.: ;Li 5-e./) D3
MEDCOM - 20092
DOD-033666
WaEd/Section:-. RINIPHYSICANW LABORATORY RESULT FORM
LAST, FIRST;
b
TEST RESULT REE RANGE
RI 3:111111
r:,atiErt Limit
Hc
tBC 19.1 H 103iL.4.5 10.5 PIC 4.99.x10'6/1.L 4.00 6.00
NI(.14gb.12.7.gfdL.11.0 13.0
lict 41.0.Z.35.0 0J) EV 32.3.FL.80.0 99.9 1-611.mai 25.6L pg.27.0 :1.0 HC 31.1! gidL.a3.0 37.0 IPit 261..x10'3IuL 150. 450.
Pli
.
44, La 3.0 *L %.7-0.5 51.1 LY#.3.*L -2:101AL.1.2 14
Sel
13at
Lyn
Atyp
RBC Morph
Spun
42-52%(M)
Hematocrit 37-47%(F)
Set Rate
Other
TEST RESULT REE RANGE
PT 9.8-13.6 secs
APTT 21-34 SESS
D dimer 20 ug/m1
FDP 10 ughrul
REMARKS: REPORTED BY:
(Subject to the Privacy Act of 1974)Lw.TIME SSN/PEEUDO SSN: .4(1(3 0
-+
°
• . 8
, . wiT410
TEST REF RANGE TE ift'ES131-T •REE RANGE
.
olor Negative PP Negative (Au 4;t0v.Iptpp;1512MM.M. ' •
. ,;:
Bili
C 1:+
Ket (qo
SG Ni 11111 Negative
Bid Ni Pt NamP: . Negative
NI
PH
mmol/L
:Prot
Pt 37C. ,
......
:Urob 0.1 PH .
Nit Nc, .DCO2.."--:: C.
Leuk Nei
• • :,:•?f•:;
HCG
• - qt nic"--/L
Cell 7. ?at :orrr, 7e;fip
Count
7.283
Directigen 38. 4 mmi-ic
P02 .112 7firoH9
-
Itt•rfgrAMA,.; 4-'4 .Pstient Temp:
• Ntl; 101.3.5F
ggff 102 : 75 UNIT Sample -P4pe_.: RRT MATCH
245EPO3 •
Oper: IIIIII,
PhQs1 , 1.5n:__
DATE:
11.1.11/7011 II MHO lat•10•17.11141.1..1710.1110.93:02VNIU M I .17.4044.37..811110,f
MEDCOM - 20093
3.-"A
DOD-033667
WanYSection: REQUESTING PHY - (\o'/G) _ 2: CHEMISTRY RESULT FORM
IC/L) 3 LAST, FERST,;Le 00 inn ,
Icp .. :-. '''•:'ti '1. A, lc •
., - vzrz: .-1--.D;,:,.;,,, ,
TEST REFULT REF.? RANGE
Na
K
CI
PH PCO2 P02 TCO2 HCO3
502
BBecf
AnGap
Ca
BUN
GLU
Creat
Het
Hgb
138446 mmol/L
3 -549 Intrlon:
98-109 Eamon
f 7.31-7.45
35-45 mmHg (art)
41 -51 mmHg (vein
80-105 minflg (art)
WA (veal
21-27 nanal/L (art)
24-29 Inman. (vet)
22-26 mmoVi. (art)
23-28 mruoUL (vett)
95-98%
(-2)-(+3) inraol/L
10-20 nunoln,
i. i 24.32 mmol/L
8-26 mg/d1
(Sub'ect to the Privacy Act of 1974) (.0 .ti I IDIAzTcE703 Tr3 0 SSN/PSEUDO SSN:
,I..:tti e.aiiiii) 'iiigiiiiieg,:::.2..
f,..-..,,r.,12:1;1...,;:i.7!..:t-:; ,,4.is::41::::.:":4,!:f.:11:.tel."7,5t44:/....:
TEST RESULT REF.
RANGE
ALB 3.5-5.5 ell
ALP 26-84 u/1
ALT 10-47 u/1
AMY 14-97 u/1
AST 11-38 un
TBri, 0.21.6 mg/di
BUN 7-22 mg/dl
CA" 8.0-10.3mg/d1
CHOL 10D-200 rag/d/
CRE 0.6-1.2 mg/d1
GLU 73.118 mg/di
TP 6.4-81 Wc11
.
..4:::::,
70-104 — "
'ES ULI' REF. RANGE
21011
. 73-118 cog/d1
:"..2
21 -.
14rj( b) G) 4 rd11,_ 7-22 mg/d1
imt,
0.6-1.2 mg/d1
AC 20..5 H Y10'3/1.1.
. i:',,.1: s'',..-IsMid. .I.;., v., , — -r .f., ,, 39-380 IA (M).:t ::,: 4.: -f
_.',..Q 1.. 0
Ho.b 10.5 1. liriL130-190o/1(0 TEST I It.t, a9 L 1 35:0 -3',/. 128-145 mmol/1
Troponin-1
Drug of Abuse
REMARKS:
rr,,T. _75, 4 :_ c 0_ .17.!.: .1.i
33-4.7 rrund/1
elt 347. - • 4E:!".
98-108 mraolll
11.1 3.4 *L. X S1.I
18-33 mmot/I
---1 --. I
REPORTED BY: ' DATE: LAB ID NO.:
:;.-:.;.74;'' iiioliiiiit li6114 -iiii .
.1;!, ,....-..,AV',..t-ilr.r-!':::,..:iKel) ,,
.•.°^''. ' n '.'"' " -- '' - - - - — - -
a:azn== PICCOLO =z zzz ==
09/25/031
10:00 F
REFERENCE RANGE 1
MAL
PATIENT # : ali ( 1?)(G)
METLYTE 8
DISC LOT #:1
3152AA
OPER #1111111 ---DR #: 00
SERI AL 77—
" 4
GLO 144*1
MG/D1
73-1181
BUNMf + +M7-22MMO/D
• CRE 1.3*1
MU/D
0.6-1.21
CK 1325*1
U/I
39-3801
NA+ 120*1
MHOS
128-1451
K+ 2.8*1
MMOV
3.3-4.71
CL-116*1
MMOV
88-1081
tCO2118-331
fff1MOM
INST OC: CK1
CHEM OC: 01
FEM 0 ,1
,1
LIP 01ICT 0
T - _s i
-
1-00a R (1
•
•1
MEDCOM -20094
Ward/Section:
REQUE ' E
,M
\U)(c) CHEMISTRY RESULT FORM (Sub ect to the Privacy Act of 1974) LAST, FIRST, MI TAO SSN/PSEUDO SSN:
(-
v i4TAt- .,.-- ..::,:rri.J.::11,,,t" -42=t -.:,: • *.. r Mkeiglitti.. -• :.:4. " Picç04.. ' iiiiikraieri:';',!,::;..,:'»
..:„.,..-,-.4.,.'-'' .2‘76:f i;:::. -.,:f2;:•:.:-.:. iN.:..,:r.:;...4rv.r.fi:.f: ,.:=Xt*..,".':',.=1"tz..-.., ,,e,. ,4=.!..-Ni".,:Viz.vi& '!,`':•:,-5...,XtS''.7;.r.it:::::•.):-. .!,,i, =•. ,....
-, ,.:!.: L.:Aer;:-7-1 , "%7:7- ' , ;-¦."',...47:2:::
TEST RESULT REF. RANGE ST RESULT REF . RANGE
138-146 mmaUL 7--73-118 me/d1
Na ======= PICCOLO ==:-:-...::::1
. --i
K 3.5-4.9 mmol/L' 03:30 PM17-22 mg/d1
09/25/031F---
MALE18.0-10.3 mgldi
Cl REFERENCE RANGE:1
98-109ulm°14-
:
111111(w,,Lf.
pH 7•31-7•45 PATIENT # 1r
35-45 mmHg (art) NETLYTE 8 128145 romo1/1PCO2 41-51 mmHg (yen) 3152M4
DISC LOT #:1
80-105 mmHg (gut) 3.7 romolil
DR #: 000
P02 N/A (veal OPER #:1TCO2 23-27 =not& (art) I 98-108 mmol/1
:
14-29 wand& (yen) SER C).L HCO3 !
22-26 mmet/L (art) . , . . O.)) 1.°) 18-33 mmo1/1 23-28 nvnol/L (vc¦11._
GLU 143*1
MG/DL .....
73-1181
95-98%
s02 r.„fgit
• • • MG/uL.1BEecf (-2) -(43) CRE 0.81
MG/DL ST RESULT REF. RANGE
Bum17-221,.,..:;:A,
0.6-1.21
tnmal/L AnGap 10-20 mmol/L CK 1263*1
U/L 7-`-'
39-3801Ca 1.12432nmwM NIVIeftr'..712871-45-44401.4..._ ..1K+ 1
2.6* 3.3-4.71
M11014_ .
BUN 8-26 mg/c11
MMOVL GLU 70105medl 4' 40 MMOVL y
CL-1114* 98-1081
tCO2118-331
0.1-1.5 roWED 11-38 u/I
Cl-EM QC: OK ' Het 38-51% PCV ,1
ICT 01
Creat INST OC: OK1
HEM 0 LIP 1+,11.
Hgb 12-17 g/dl I -- .S.4-a-:' . ,tiiiiiii '' /VA - iX 64-8.1 g/d1
•:-;::::-".-f- "4"Arl*,
.
TEST RESULT REF RANGE Teof-f•••fIf ::_-......::::.
.i.
Troponia-1 IP. ST RESULT
,
128-145 mrnolfl
Drug of
Abuse
3.3-4.7 mmoIfl
98-108 mraoLil
18-33 mmol/1
E
REMARKS:
REPORTED BY: DATE: LAB ID NO.:
MEDCOM - 20095
Ward/Section; REQUESTING PHYSICIAN , /I ¦ i i ¦ .z..... ' CHEMISTRY RESUALaTofF104)
97RMCu '3 (Subject to the Privacy
11111111,
LAST, MST, MI-4 "s. i, a. DATE TIME SSN/PSEUDO SSN:
r
T :7,51:4.5,..,;A:liv..
• ,_ .
..j,i2::::;::y.,,Tt:.::!,,
,:-.•".*;..i.'$.,..,3.....,:.:,:c.,qi.-i.".---.
• 4. .=-'...74,ge4.474-9...74',W:,
TEST RESULT REF. RANGE TEST RESULT REF. TEST RESULT REF. RANGE RANGE
a 138-146 mmol/L • — 3.5-5.5 0 GLU 73-118 mg/d1
K 3.5-4.9 nuno1/1; ,1 7-22 mWdl
-4
98-109 mmol/L 8.0-10.3 mg/d1 ======= PICCOLO 4.-_-
7.37.51-4 z:.-a 0.64.2 mg/di
PH 08/25/03
' 12:45 PM +
PCO2 3545 mmHg (art) REFERENCE F i 128-145 mmol/I
41-51 anolla(vez0 '3E. ,
80.105 mmHg on)
L.
P02
PATIENT i: 13.3-4.7 romolft
14/A (vou1 air (10A0 Lf
METLYTE , r
TCO2 mmol/1.(an) ,..,
23-27 mmol/1.98-108 mmo1/1 24-29 awnal/L (yen) •
U I SC LOT # •111
HCO3 22-26 mrnoa (art) opER #: 3141M4118-33 mmol/1
02
23-2S mrnol/L Noll
95-9814
s02 SERA/ DR II: 000 '53 .4c-.9. . "„ !,,f,-i 11 ¦*"."114::::-.....:-;:-:-..:
•. . .¦,10A...3:.-=== REF. RANGE
Bad. (-2)-0'3/ ............. risr RESULT
nanol/L GLU.
155*
3-1181
suNM• 4 . 7_22 MG/DL13.3-5.5 Wc11
AnGap 10-20 mmon.M LB
MG/DL1
Ca 1.12-1.32 nunoli! CRE LP 26-a4 u/1
0.81
0.6-1.21
MG/DL
CK1 10-47 un
BUN 8-26 mg/c11 1156*1•LT
39-3801
U/L
NA+1
120*
128-145114-97 u/1
MMOZ/L1
GLU 7(1°5 inedi104Y
'K+1
2.3*1
3.3-4.71
frIvIOR..
CL-
0.7-1.5 mEina 114*1 11-38 u/1
Creat 98-1081
MMOi/L1
°'ST
tCO2 •• •
Het 38-51% PCV 18-33 Mott.MIL 0.2-1.6 mg/d1
HO) 12-17M"d1 GGT 5-65 u/1
INST QC'1
OK
44 . CHEM OC: OK16.4-8.1 Wc11
,,, ::,...,..f, ,i....-* .-.?,;:::!,,...;.:. ...,::,r,.,x,. ...., ., ,,-„z•,,,, .,„. ' HEM 0 ,1
LIP 010 TP
. ,1
,::::-.:,: ICT1
TEST RESULT. REF. RANG
014100f3
, • .
.f, .;.,•c:,,...Q.,...,,-.:
r Troponin-/ TEST RESULT REF. RANGE
.
Drug of NA* 128-145 mmo1/1 Abuse
3.3-4.7 mmol/1
K4
t
98-108 mmolll
CL:
18-33 minoUl
tCO2
REMARKS:
REPORTED BY: --" DATE: LAB ID NO.:
MEDCOM -20096
CHEMISTRY RESULT FORM
Suliect to the Privacy Act of 1974) SSN/PSEUDO SSN:
•
RESULT REF. RANGE
PICCOLO 13.5-5.5 gid! 73-118 mg/dl 25/09/03126-84 till 7-22 mg/d1
04:58
1 REFERENCE RANGE:.MALE
cl •1
8.0-10.3 mg/dl
PATIENT #:
1
pH 14-97 u/1 0.6 12 mg/d1
1
METLYTE 8
Pc02 11-38 u/1 128-145 mmol/1
DISC LOT #: 3141AA4
DR #: 000
2-1.6 mg/dl 3.3.4.7 rainolll
7-22 rug/d1.CL" 98-108 rnmo1/1
18-33 mmo1/1
134* 73-118 s02 BUN AO- M.7-22 MG/DL BEecf
GLU1MG/DL -I
CRE10.5* 0.6-1.2 MG/DL REF. RANGE CK1U/L
•.• 39-380
3.3-5.5 WdI
NA+1-40-*PT128-145 MMOVL
1
26-84 u/1
K+13.3-4.7
3.31MMOtL
10-47 u/I
110* 98-108
tCO2 44*d318-33 MMOfiL
CL-1MMOIYL
14-97 ull
Creat.INST GC: OK.CHEM GC: OK 11-38 u/I
Hct.HEM 0 , LIP 0.ICT 0 0.27 1.6 mg/dl Hgb Lints -a 17.9 R f.10 '3 , d..4.5 10.5
6.4-8.1 g/dl
a: 4.41.f.10'6PIL i.0 &00 -lib 11.2.glaL.11.0 18.0 G 15..0
TIL.'30.0 99.° 'L 01.REF. RANGE
1Cti.27.0 31.c, -e33 31.2L slciL.:3.0 7.0 it 279..slirAL 150. :z50, 128-145 mmol/1 LfZ 3.9 ,L k.20.c 51.1
0.7 0._ :e10'3.'tL.1.2.3.4 3.3-4.7 mmol/1
98-108 mmoL1
18-33 nunoUl
REPORTED BY: DATE: LAB II) NO.:
MEDCOM - 20097
Ward/Section:A3 REQIIIIIVAN:(6 ye) LABORATORY RESULT FORM
-2_
(Subject to the Privacy Act of 1974)
LAST, FIRS,T,MI. DATE Til VIE SSN/PEEUDO SSN:
e.. 9 ‘./...i Ct ) i _ I•, UV s4 0
z g , 7 „., , , I prp ' , ,. L .f, 0 ..- - ,.. ,:,,,
7,, ,
,VO4.,'.!.ALLfi 'S ‘ " e ' '' .1t
k gmtiol"., ,.'''t.Js' ,.'W S 24 I'M '1,YM
cl-.''.'A l''''M... "4'W.4.C.
-TEST _.. RES'ULT" • -ANGR TEST RESULT REE RANGE TEST RESULT REE RANGE
WE _Dior N/A RPR Negative
RB PP N/A Mono Negative
PICCOLO .
x u Negative
Hgl.--..."..".."-"."---
lga2'g Cro V irtrirWP
-09/5/03.12:46 AM toz,..twateI z.,,,,le.a..,..;‘,/,..n.,. ".:.,x .':,:‘, '..11-,
Hct Negative Source
REFERENCE RANGE :.MAI _F..NI'
PAT I ENT # : 11111.0D104.
MC Cet Negative Gram
MET LY TE 8 Stain
Pit DI SC LOT #:.3021 AA1.4. c Bid Negative
Lyn OPER # : MB.DR # : 000.ff pylori Negative
SER I,N, # : / _
$ cro
(.. ) (417-.--ras itcs
(LU.132*.73-118 MG/9L,-r.
aria
BUN..31ti:L 1,*- 22.MG/OL. Bat CRE.0.9.0.6-1.2.MG/ D!_.T;. & P --E; CK.Ott 39-380 U/L
4i (00 Li-:her
' NA+ 4**11-61 28-145.MGM_.
•,..1.
,,,..AM:",•,4iM,.......4
Aty K +.3.7.3.3-4.7.r110//L A.AIN.2509-f)3.VO'
.,10:46 .'
-
.CL -.110 .
* 98-108 MOM__.,7-, 8
tt PAiert
RN tCO2.29.18-33.11\10VL.-.
12.14iTS
MoiM
WIC 16.9 H x1(03/uL 4.5 10.5 ----.INST OC: OK.CHEM GC: OK.RIC 4.50 x10"6/uL 4.0 6.0
ism .
Hgb.11.6.OIL.11.0.18.0.$.a A ;`: %.
SPU.HEM 0.3.LI P 0.3MI CT 0.
Hem Hct7.4 Z 35.0 60.0 ,' 44°..., -••--. d.ralfB3.1.ft..80.0.9?.9 -,.' Set. :e EH :5.7 L PS.27. 31.0 LUST SUBMIT SF 518 WITH '" :la 50.9 L 9/0L 72.0 37.0.VERY UNIT REQUESTED L" Pit.245..If10'3/ilL.150..450. Othe )i La 4.1.,i'l_ Z.20.5.51.1.BO/Rh CR.0.7 € r.101.3hL.1.2.3.4
t .S F F A4 IMfk^ ' 4, ''''M44 ,,iMA A'.' 0' ¦-,4t , a , .9.(
-
1,We.:2 --, TE v.v., 1 1 PZ CROSSMATCH
PT
APT.
D dimer 20 ug/ml
FDP 10 ug lmt
REMARKS:
REPORTED BY: DATE: j LAB ID NO.:
MEDCOM -20098
DOD-033672
Ward/Section: REQUESTING PHYSICIAN:
' CHEMISTRY RESULT FORM It 0 3 (Subject to the Privacy Act of 1974)
(46) Z NOS
LAST, FIRST, MI. DATE TIME SSN/PSEUDO SS -
fill b (4 6 L\ ' ,i 74/(0.3 OLIO
...i;A: -.AT,-,-S1;').;i: ,,.:T11.. -;,4';'Si..,, :-..; .'1.....5.,' -.10,0° --244. P ..aili ,,• e
''''''''';','.:" .' -T''' :'; ' '1: &:
TEST RESULT REF. GE TEST RESULT REF. TEST ' RESULT 'REF --GE RANGE Na 138-146 mmon ALB 73-118 mg/di
3-5'5-5 01 GLU
K 354.9 min01/1; ALP 26-84 ufl 7-22 mg/411
"M'...-
CI 98-109 mrnol/L ALT 8.0-10.3 mg/dl
PH 7.31-7.45 AMY 0.64.2 mg/d1
.
PICCOLO
PCO2 35-45 mmHg WO AST ....... 128-145 romo1/1
43-51 =Ea (veal 04:34 AM
P02 80-105 mmHg (art) TBIL 09/28/03 MALE 3.3-4.7 raroult1
N/A (,ven1 REFERENCE RANGE:
TCO2 23-27 1/L (art) BuN
98-108 mmol/1
24-29 (von) PATIENT #: )61-
HCO3 22-26 mmol/L (811)
CA++ BASIC 11EIAB#111r 18-33 mmol/1
23-28 :mak. (ven)
3145AA/1
1
-. P
95-98% DISC LOT #:
s02 CHOL -1I PS '—:...
" O
NW DR #:.000.''.::,.7f..ril.nk. ;..,;„.!.,„..
OPER #:
BEecf (-2)—(4-31 CR , MT REF. RANGE
rurnaL s ,v1._ # .. ./....0111111. 10-20 mmol/L - )77 .................
AnGap GL 33-5.5 Vd1
CP.50
MG/DL
Ca 1.12-1.32 mmol/L TP 132t.73-118 26-84 u/1
(I_U
MG/DL
fife 7-22
BUN 8-26 mg/c11 '' BUN 10-47 &I
.0-10
8.3
' --. D/10-4-.9.0.
MG/11-
GI -) )t'"'' CRE 0 6 et0'6 -1'2 14-97 WI
'
'F------
--.. ,. ..
Cs Th. 11-38 t ill
;)i:).-.:
K+ i1
3'3-4'
3•°*1
He D;7ic-ut *s+ 112150:19:1: l'ill11 0.2:1.6 rng/d1
CL-
Hp ..Irgts ;i 1-1140/A-
444'i7" % 1833.5-65 u/1
' UPC IS. 53 ;1 :0'.51i.:_ :i..5 tCO21
• '.:5-, ... ¦-,./ ,f7.1-V-f fa.f, 4.1VC,.,) 6.4-8.1 g/d1
c - - ---¦ .•••.•-•.'.• ci_Em pc:1
it.i)1
0 K
••'''''.rig)
.7 7: L La! a. ihu1 OK
INST OC:
31,6 L I t,.:.1.fi 01;',
3f,.f.' ICT1Mani! .
F_Et.i 0 , LIF'.0.,
:— Si. 4 11 ;, :;,3 .%.. ''ri 1: L . ..-.JI r.
REF. RANGE
73i-2 a,1* L .i:i•-.ri :7,f)
Dr' Kt 347.f:-:::( .t , -M. 128-145 mmol/1
Ab L:7. 4.3 6: r., ,I.
3.3-4.7 mmo1/1
98-108 mmoVI
18-33 nuno1/1
I
REMARKS:
REPORTED BY: 1 _-......, nth:
•
I
MEDCOM - 20099