Medical Report: 25-Year-Old Iraqi Male, Baghdad, Iraq re: Shrapnel Wounds Torso, Chest and Flank: Amputation Injury

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Medical records of a 25 year-old Iraqi male with shrapnel to flank and amputation injury. The medical records do not state how the gentleman received his injuries and does not give any personal information on the him.

Doc_type: 
Medical
Doc_date: 
Friday, April 11, 2003
Doc_rel_date: 
Monday, May 30, 2005
Doc_text: 

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If ,ENT TREATMENT RECORD COVERt ;
For use of this form, see AR 40-400; the proponent agency is 01-SG
1. REGISTER NUMBER NAME (Last, First, MI) (b)(8)-4 3. GRADE ADMISSION REMARKS
4. EX b. AUL . RACE 7. RELIGION 8. LENGTH OF SVC 9. ETS 10. PREVIOUS ADMISSION
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24. NAME/RELATIONSHIP OF EMERGENCY ADDRESSEE 25. TYPE DISPOSITION 26. DATE OF DISPOSITION
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27a. ADDRESS OF EMERGENCY ADDRESSEE (Include ZIP Coda) 27b. TELEPHONE NO. 28. DATE OFT ADMITTING OFFICER ADMISSIO
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29. NAME AND LOCATION OF MEDICAL TREATMENT FACILITY I. DATE OF INTIAL 32. UNITS OF WHOLE BLOOD/ ADMISSION COMPONENT TRANSFUSED
86TH COMBAT SUPPORT HOSPITAL, LSA ADDER, IRAQ
31. SELECTED ADMINISTRATIVE DATA -
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33.
CAUSE OF INJURY

34.
DIAGNOSES/OPERATIONS AND SPECIAL PROCEDURES

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35. Total Days This Facility
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SUPPLEMENTAL TOTAL SICK DAYS
CARE DAYS CARE DAYS

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36. Total Days All Facilites
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DOD 010423

.JICAL RECORD • NURSING DISCHARGE SUI....:_ARY
For use of this form, see AR 40-66; the proponent agency is OTSG
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7. Medications: • No Medication Required
Name of Medication Dosage Frequency of Medication Special Instructions

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12. Additional Information:
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MEDCOM - 3945
DOD 010424

MEDIL,.- RECORD- NURSING DISCHARGL
For use of this form, see AR 40-66; the proponent agency is OTSG
. Date/Time: Discharge to: 111 Home Other (specify) . Accompanied by:
3. Mode: . Ambulatory Other (specify)
. Activity: . Limitations (specify)

Patient and/or Significant Other (S.O.) communicates knowledge and understanding of activity limitations.
. Diet: . No Dietary Restrictions If special, identify Patient/S.0. communicates understanding of dietary restrictions. I 7. Medications: . No Medication Required
(b)(6)-2,(b)(6)-4
Patient and/or S.O. communicates knowledge and understanding of name, dosage, frequency and special
8. Treatments/Care:
Patient/S.0. observed Patient/S.0. Returned Instructions Given: Demonstrations (Date) Demonstration (Date)
b)(6)-2,(b56)-4
Equipment/Supplies (Specify)
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clinic in (time period).
9. Follow-up: You should be seen
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10. Patient's Condition
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12. Additional Information:11. Signature (Registered Nurse)
13. Patient Identification:
COPY 1 - INPATIENT RECORD COPY
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MEDCOM - 3946 1%.

DOD 010425

NSN 7540.014751786
TIME SEEN BY PROVIDER
EMERGENCY CARE AND TREATMENT
MEDICAL RECORD
(Doctor)
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Medical Record STANDARD FORM 558 (REV. 9.96)
Prescribed by GSA(ICMR FPMR 141 CFRI 101.11203MM USAPA VI.00
MEDCOM - 3947
DOD 010426

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NSN 7540-01.075-3788
LOG NUMBER TREATMENT FACILITY
EMERGENCY CARE
MEDICAL RECORD AND TREATMENT
RECORDS MAINTAINED AT
(Patient)
PATIENT'S HOME ADDRESS OR DUTY STATION
ARRIVAL
STREET ADDRESS
DATE (Day, Month, Year) TIME
CITY
STATE ZIP CODE TRANSPORTATION TO FACIUTY
SEX DUTY/LOCAL PHONE MILITARY STATUS THIRD PARTY INSURANCE
AREA CODE NUMBER ITEM YES NO NIA ITEM YES NO
PRP ADDITIONAL INSURANCE
AGE HOME PHONE FLYING STATUS DO 2568 IN CHART
AREA CODE NUMBER MEDICAL HISTORY OBTAINED FROM NAME OF INSURANCE COMPANY

CURRENT MEDICATIONS INJURY OR OCCUPATIONAL ILLNESS EMERGENCY ROOM VISIT
WHEN Ole) DATE LAST VISIT 24 HOUR RETURN
ITEM YES NO n YES.ri NO IS THIS AN INJURY?
WHERE TETANUS ALLERGIES INJURYISAFETY FORMS
DATE LAST SHOT COMPLETED INTITIAL SERIES HOW
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CHIEF COMPLAINT
CATEGORY OF TREATMENT
VITAL SIGNS TIME TIME
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PULSE
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ACUTE ABDOMEN LS SPINE BLOOD C&S X
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DISPOSITION DISPOSITION QUARTERS /OFF DUTY PATIENT/DISCHARGE INSTRUCTIONS n HOME.n FULL DUTY n 24 HRS..n 48 HRS..n 78 HRS. MODIFIED DUTY UNTIL RETURN TO DUTY
CONDITION UPON RELEASE ADMIT TO UNIT/SERVICE low TO WHEN
REFERRED.IMPROVED. UNCHANGED
DETERIORATED TIME OF RELEASE I have received and understand these instructions.
PATIENT'S SIGNATURE
PATIENT'S IDENTIFICATION trot typed or written &wigs, give: Name kst, fin% midge; ID an. ISSN or calk• hospitil medical &aryl
:b)(6)-4
EMERGENCY CARE AND TREATMENT (Patient)
Medical Record
STANDARD FORM 558 (REV. 9-981 Prescribed by GSAIICMR FPMR 141 CMI 101.11.203(bH101 USAPA VI.00
MEDCOM - 3948
DOD 010427

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MEDCOM - 3949
DOD 010428
AUTHORIZED FOR LOCAL REPRODUCTION
MEDICAL RECORD PROGRESS NOTES
DATE NOTES
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RECORDS MAINTAINED AT
• • • ‘ •N: For typed or written entries, give: Name - lest, first, middle; REGISTER NO.
b)(6) WARD NO.
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PROGRESS NOTES Medical Record
STANDARD FORM 509 (REV. 5-99)
Prescnbed by GSNICMR FPMR (41 CFR) 101-11.203(bX10)
MEDCOM - 3950
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DOD 010429

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MEDCOM - 3951
DOD 010430

AUTHORIZED FOR LOCAL REPRODUCTION
MEDICAL RECORD PROGRESS NOTES
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MEDCOM -3952
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DOD 010431

AUTHORIZED FOR LOCAL REPRODUCTION
MEDICAL RECORD PROGRESS NOTES
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STANDARD FORM 509 (REV 5-99) Prescribed by GSAACMR FPMR (41 CFR) 101-11.203(b)(10)
MEDCOM - 3953
DOD 010432

DATE NOTES
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MEDCOM - 3954
DOD 010433

AUTHORIZED FOR LOCAL REPRODUCTION
MEDICAL RECORD PROGRESS NOTES
DATE NOTES
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