Medical Report; 20-Year-Old Iraqi Male, Detainee, Baghdad, Iraq re: Gunshot Wound to Pelvis and Thigh

Medical records on a 20 year-old Iraqi male detainee who was shot twice in the pelvis, thigh and arm. TThe medical records do not state how the detainee received his injuries and does not give any personal information on the detainee.

Doc_type: 
Physical (non-death)
Doc_date: 
Friday, October 10, 2003
Doc_rel_date: 
Friday, October 14, 2005
Doc_text: 

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)1- rtl 't r'" 1 T­6Jet. 0 rea ),zir Mir A

WARD NO.
(Continue on reverse side)
REGISTER NO.
Nome—last. first. middle:
give:
or written entries medical focally) PROGRESS NOTES PARENT'S ,DENT¦ FicKnoN7n, typed k; rote: hospital or
grade: ran
STANDARD FORM 509 (Rev. IS-77) ?Mated IN GSA/OR ,
WO 101-11•36-
MIR (II 509-11 0
MEDCOM - 21254
DOD-034830
AUTHORIZED FOR LOCAL REPRODUCTION
CHRONOLOGICAL RECORD OF MEDICAL CARE
MEDICAL RECORD
SYMPTOMS, DIAGNOSIS, TREATMENT, TREATING ORGANIZATION (Sign each entry/
DATE
efA, Co
It)
41° af
q__75 L
RECORDS MAINTAINED ATDEPART./SERVICE
STATUSHOSPITAL OR MEDICAL FACILITY RELATIONSHIP TO SPONSORSSN/ID NO.
SPONSOR'S NAME WARD NO.
IREGISTER NO.
(For typed or written entries, give: Name - last, first, middle; ID No or SSN; Sex;
PATIENTS IDENTIFICATION:
Date of Birth; Artnk/Grade.) i ()) ........k.f.

CHRONOLOGICAL RECORD OF MEDICAL CARE Medical Record STANDARD FORM 600 1REV. 6-97)
Proscribed by GSA/ICMR FIRMR 141 CFRI 201-9.202-1
MEDCOM - 21255
DOD-034831
AUTHORIZED FOR LOCAL REPRODUCTION
PROGRESS NOTES
MEDICAL RECORD NOTES
DATE yin P ry

sisx, vo -calm (IL GP
0-AA/UtUl) 01 A itchu).

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\WI'S
SPONSOR'S ID NUME
ISSN or Other)
RELATIONSHIP TO SPONSOR
RECORDS MAINTAINED AT
DEPART ./SERVICE
iddle; (For typed or written entries, give: Name - last, first, m
((3) 1
PROGRESS NOTES
f Birth; Rank/Grade) \to
PATIENT'S IDENTIFICATION: ID No or SSN; Sex; Data of
Medical Record
(RE
STANDARD FORM 509
Prescribed by GSAIICMR FPMR 141 CFR) 101-11
56
DOD-034832

MIDDLE INITIAL ID NUMBER
S ANDARD FORM 509
(REV. 5/1999) BACK
USAPA V1.00
MEDCOM - 21257
DOD-034833
AUTHORIZED FOR MAL REPRODUCTION
PROGRESS NOTES
MEDICAL RECORD
NOTES
SPONSEIFII ID NUMBER
(MX or Merl •
RELATIONSHIP TO SPONSOR
RECORDS MAINTAINED AT
DEPARTJSERYICE WARD NO.
PATIENTS IDENTIFICATION: (For typed or written entries, give: Na • 114 Via mid*:
lionlAnde1
. No or SSt Sec Date of PROGRESS NOTES
Medical Record STANDARD FORM 509 IREV. 611E
05)—y
Pmsaibed by GSANCIAR FPMR 141CFRI 101-11.2 03iM USAPA V
DOD-034834

AUTHORIZED FOR LOCAL REPRODUCTION
PROGRESS NOTES
MEDICAL RECORD

RELATIONSHIP TO SPONSOR
RECORDS MAINTAINED AT
DEPART ./SERV I CE
(For typed or written entries, give: Name - last, first, middle;
PATIENT'S IDENTIFICATION: ID No or SSN; Sex; Date of Birth; ff k. Grade) PROGRESS NOTES
Medical Record
STANDARD FORM 509 (REV. 5/19! 03H
Prescribed by GSA/ICMR FPMR I41CFR) 101-11.203AUSAP V I
259

DOD-034835

MIUDLE INITIAL ID NUMBER
DATE NOTES
7 iLpt.s PAI-(r6--))6)-2..
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fizr C G v... 5
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k,
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r.,,,.. p"..rs ,LE--c 2- . • , ; L . u . s-., • 0 ,,, , ,.::.
.ILIP
4 ¦ --• .. • i...-__.. cLa r_t ' • _ IsL.. • ft.-_ Co a
. +1. l•-e--P-1.,.., i-0,1 • - --
STANDARD FORM 509 (REV. 5/1999) BACK USAPA V1.00
MEDCOM - 21260
DOD-034836
MIDDLE INITIAL ID NUMBER
_AST NAME
(REV. 5/1999)E
STANDARD FORM 509
SAP)
MEDCOM - 21261
DOD-034837
NSN 7540-01-075. 3786
TREA
EMERGENCY CARE RECORDS MAINTAINED AT
AND TREATMENT
MEDICAL RECORD (Patient)

ARRIVAL
TIME
PATIENT'S HOME ADDRESS OR DUTY STATION
:STREET ADORE TRANSPORTATION TO FACILITY
e.IVOC THIRD PARTY INSURANCE
\
CITY ND
11
W111111111111:12213
DUTYILOCAL PHONE
111231011011
ADDITIONAL INSURANCE
SEX VIM
AREA CODE DO 2566 IN CHART
`NM
NAME OF INSURANCE COMPANY HOME PHON
MEDICAL HISTORY OBTAINED FROM
AGE
EMERGENCY ROOM VISIT
AREA CODE INJURY OR OCCUPATIONAL ILLNESS 24 HOUR RETURN '
DATE LAST VISIT YES NO
CURRENT MEDICATIONS
NO •
Na
TETANUS --COMPLETED INTITIAL ETESDATE LAST SHOT
NO0 YES -0
INJURYISAFETY FORMS 1112IS II I
ALLERGIES

CHIEF COMPLAINT
lY1
VITAL SIGNS
MEM
CATEGORY OF TREATMENT
TIME
EMERGENT 11111111111111

111.11111111
URGENT INITIALS
101111111111111111111
11111
C-SPINE
CXR PA & LATIPORTABLE
ION-URGENT LS SPINE
BHCGIURINEIBLOODIOUAN T a
¦ ACUTE ABDOMEN
CBCIDIFF 1111331111111231111111111 HEAD CT
›- CC
CC
k
1111013311111111 ¢
1111=1111111.111111111
BLOOD C&S X
I • ECG
ORDERS
MONITOR PATIENT'S RESPONSE
COMPLETED BY
• PULSE OX
ORDERS

TIME
PATIENTIOISCHARGE INSTRUCTIONS DISPOSITION QUARTERS loEE DUTY
DISPOSITION 78 HRS.
48 HRS.
24 HRS.
FULL DUTYHOME
RETURN TO DUTY
MODIFIED DUTY UNTIL WHEN

ADMIT TO UNITISERVICE REFERRED
CONDITION UPON RELEASE

received and understand these instructions.
UNCHANGED I have
CI IMPROVED TIME OF RELEASE
PATIENT'S SIGNATURE
CI DETERIORATED
-lase
(Fol typed or written entries, give. Name
PATIENT'S IDENTIFICATION lust. middle' 10 no. ON fr other/; hospital m
medical facility'

EMERGENCY CARE AND TREATMENT (Patient)
Medical Record
STANDARD FORM 5581REV. 9-961 Plescaol by GSAIICMF1 f PIM 141 UM loi.11.2630Atio)
USAPA V1.00
MEDCOM -21262
DOD-034838

0o0 IMPLI I.00
MEDICAL RECORD EMERGENCY CARE AND TREATMENT (Doctor) TIME SEEN BY PROVIDER
TEST RESULTS
WBC ABGIPULSE OX RADIOLOGY Check if read by radiologist
HIH SUP 02 PH P02 RESULTS
PLT PCO2 SAT OTHER
PT DIP EKG INTERPRETATION
APTT BHCG ETCH GW MICRO
PROVIDER HISTORYIPHYSICAL 712,1-#--rt-4-11-/L-4-t d 7i" 717.4_ s/ P (Z)3 .
73° t7C eT°3 / 24 11 4-- eS-4 p7 -cq „ ---All!16-

CONSULT WITH TIME ACTION RESIDENT/ EDIC NT SIGNATURE AND STAMP
DIAGNOSIS P
PATIENT'S IDENTIFICATION For oyes or written entries, give, Name - less, fest, middle; ID no. ISSN Of oared. hospital or nese, feelkyl 111111'(') ' EMERGENCY CARE AND TREATMENT (Doctor) Medical Record STANDARD FORM 558 IREV. 9-96I Prescribed by GSAI1CMR FPMR 141 CFR; 10 1•11.21:131611101 USAPA VI.00

MEDCOM - 21263
DOD-034839
NURSING NOTES
(Sign all notes) OBSERVATIONS Include medication and treatment when indicated
MEDCOM - 21264 STANDARD FORM 510 (REV
DOD-034840

OCUMENT INTRAOPERA ;icy is the office of The Surgeon General. -66, the propos, VIEWED AND PROCEDURE
For use of this form, see AR 40 R
2. PATIENT IDENTIFIED, RECORD
MEDICAL RECORD
ROOM VERIFIED BY 2
BY
1. PATIENT TRANSPORTED TO OPE R
Oirt/f— 4. PATIENT IN ROOM
NUMBER
6
TIME PA IENT ARRIVED IN SUITE
VIA ‘...t TIME INC TIME • it/5 /1.‘c OTHER (Specify)
3. DATE
5. PREOPERATIVE EMOTIONAL STATUS
. WITHDRAWN .
06'

. ANGRY
CRYING
. EXCITED . ANXIOUS
CALM
.
COMMENTS:
.et.-12 (Pr 6. NURSING PERSONNEL
RELIEF
\AO A--
SCRUB
ASSIGNED
SCRUB

2
RELIEF CIRCULATOR2L1
ASSIGNED CIRCULATOR 0 RIGHT SIDE UP
(Specify) . LEFT SIDE UP
LATERAL: 0 KRASKE
7. POSITION AND POSITIONAL AIDS
. PRONE
0 LITHOTOMY SUPINE

AI
S. SKIN PREPARATION eINDWECOMMENTS:
PREP S UTION (Specify)
BY WHOM:
Lgt, 19 Li)
NO SITE: BY WHOM: NURSING UNIT
HAIR REMOVAL 0 YES •
SITE:OR
DONE BY: . RAZOR
.
DEPILATORY
METHOD: r-
COMMENTS:
CLIP
.
:
COMMENTS
-NLAN
9. LOCATION OF EXTERNAL DEVICES
M111411111111ter...
Afiri2.91:44 15V1
'411111r
• ...--
-, ....
ID -........,..-..-¦Iiiiiiiiiiiimil•IIIIIIII.....­
-
It"
_At ''s
IA Illlit-iiii•

=== Tourniquet
— Safety Strap
X Ground Pad CIRCULATOR
C = Correct I = Incorrect
LEGEND
19 (3 —I—
Closing Final Closing
SCRUB
First
Count Other" Count
10. COUNTS 11111111111
. No MN
0 Yes
11111111111 15
sponge . No
.4 Yes
Needle Sharp 111111111111111 0 Yes b. 11111111111 ELECTROSURGERY DEVICE(S) (ESU)
1111111111111111111
Instrument
12.
Yes .4 No 1111111111
written entries give:
Other O or typed or Facility;)
6
PATIENT IDENTIFICATI Hospital or Medical -5E1)
1/11
11. (ESU NO:
30'1
Last, first, middle; Grade; Date; BRAND
Name -
? GROUND PAD: LOT NO:
b
. ESU NO:

BRAND
GROUND PAD:N/Itit LOT NO:
5
BIPOLAR NO:
b1111111/
b¦d — .
MEDCOM - 21265
DOD-034841

,L NO IF YES NAME: ID NUMB JUI-AL; I UKtIl
13. PROSTHESIS, IMPLANTS . ;:i MEDICATIONS/ORDERS,,::„ '3 ,. g.
1 . J.:: . 4'',.Z,O,'. wa., , ;;, PT:- ' ; , :4K,, :,. -
NO V,
IRRIGATION/MEDICATIONS GIVEN IN OPERATING ROOM (NOT BY ANESTHESIA) YES • METHOD PREPARED BY.
DOSAGE TIME...
MEDICATIONS/SOLUTION
p5
:WOUND IRRIGATION Ki YES . NO, TYPE(S): TIME CARRIED OUT BY;OTHER ORDERS ;,
.cti
'PHYSICIAN'S SIGNATURE
IF YES, SITE
15. X-RAY IN OPERATING ROOM
YES NO
r
LABORATORY SPECIMEN
16.
NAMESPECIMEN (S) NAME
YES . NO lyr FROZEN SECTION (FS) NAME NAME
YES . NO NAMECULTURE (C) NAME
YES . NO NAME
NAME NAME 18. DRESSING/IMMOBILIZATION (Specify)NAME NAME
Kalor-01z-w.
17. TUBES, DRAINS/PACKING YES NO •
liki Ors'ISIV
TYPE/SIZE 1. 2.

-Ve..-i.ix
10,.. ri,ki ,-)7 Ace kA), ..e
SITE _,,, . 3.
1 ,de,Y4AA 6(4)e 0
(9 1 IN15k s
19. ADDITIONAL INFORMATION
51-kor -1,--: 13351,4,
tri.11--E" -- 153 I m ,

--51..- )a)fri_
20. OPERATION(S) PERFORMED
PI
'1-1'N,--A)N's I 1)ep".;.-k G--) Pt,.-A-- -E Eyk----t -F;x..76,--6 Ci.L- i-6-A.,r-6(6)-L.
21. PATIENT TRANSFERRED TO 1TIMeEi. Li kir.t 1 METHOD
1_31— (elk 1.--C1rErz., MEDCOM - 21266
122. REGISTERED NURSE SIGN
DOD-034842
INTRAOPERATIVF DOCUMENTMEDICAL RECORD
For use of this form, see AR 40-407, the propon 3cy is the office of The Surgeon General. . ,
JM 2. PATIENT IDENTIFIE LORD REVI WED AND PROCEDURE
1. PATIENT TRANSPORTED TO OPERATII' - VIA j.t„4:a).1) BY at./1.-e--4, -4.4-4.-R_A-VERIFIED BY aerr/A-A3
TIME PATIENT ARRIVED IN SUITE 4. PATIENT I TIME 045-3 NUMBER /"! ()
3. DATE
gOeT-03
5. PREOPERATIVE EMOTIONAL STAT S
cg. CALM . ANXIOUS • EXCITED U CRYING • ANG • WITHDRAWN • OTHER (Specify)
OMMENTS:
piLii:efoi,,,,_„4,,,,,..,4.,:m .... 1 („fo)...2
. .......... .

6. NUR51NGT)ERSO NE/
EL
ASSIGNED a IIIIIII4 .----.Itio-.. --"RELIEF
'SS
SCRUB

SCRUB
ASSIGNED C..;Pr i G6 RELIEF
CIRCULATOR . .__. _ ..... . __CIRCULATOR

7. POSITION AND POSITIONAL AIDS (Specify) --,-
g
SUPINE • LITHOTOMY • PRONE • KRASKE. LATERAL: • LEFT SIDE UP • RIGHT SIDE UP
COMMENTS:
b LC) -L
8. SKIN PREPARATION -
HAIR REMOVAL • YES NO PREP • UTION (Specify) 4e,.."-X1 r..6e.„/e-
DONE BY: • OR • NURSING UNIT SIT AOCQJ B WHOM: ejor-

METHOD: U DEPILATORY • RAZOR . 2 SITE:.s- BY WHOM:
• CLIP
--r---. COMMENTS: .. COMMENTS: 11-.0 IC2-d—i--&-+',..81 rile, A4 d
9. LOCATION OF EXTERNAL DEVICES
. _

• .-
-, t :OE-.-
-'°¦--**Namemmo.--.-

• -Torim---
......_..

LEGEND X Ground Pad ety Strap = = = Tourniguet-• ••-:-•:.-­

C•= Correct I = Incorrect
vt § V-10., I First Closing Final Closing
10. COUNTS Other•• Count .. i ,:. CoLint .SCRUB ' IRCULATOR
Sponge Yes Vo e_
Needle Sharp Yes Vo

- _
Instrument D Yes Vo _ ,. Ur.;11:1_,.:, ,
_ ..
Other U Yes Vo

11. PATIENT IDENTIFICATION For typed or written entries give: 12. ELECTROSURGERY DEVICE('.) (ESU) • YES NO
. iil,
Name - Last, first, middle; Grad • • Hospital or Medical Facility;)
Co AG
ESU NO:
GROUND PAD:: i •A i- 7S-7) -
\I/A- _..._._
. . , LOT NO: 0 Oil -, .1-c) 0 5--Cy-.:':'..ESU NO:
NO:
... ,• . .. • •"GROUND PAD: BRAND
. r ._..
LOT NO:
r-1 nine. A [I
NO: MEDCOM - 21267
g (0 dr 0 3 I
DOD-034843

Doc_nid: 
3949
Doc_type_num: 
77