Medical Report: 25-Year-Old Iraqi Male, Detainee, Abu Ghraib Prison, Baghdad, Iraq re: Gunshot Wounds to the Chest

CLINICAL RECORD - DOCTOR'S ORDERS
For use of this form, see AR 40-66, the proponent agency is OTSG

THE DOCTOR SHALL RECORD DATE, TIME AND SIGN EACH SET OF ORDERS. IF PROBLEM ORIENTED MEDICAL RECORD
SYSTEM IS USED, WRITE PROBLEM NUMBER IN COLUMN INDICATED BY ARROW BELOW.

PATIENT IDENTIFICATION DATE OF ORDER LIST TIME
. TIME OF ORDER
ORDER NOTED AND
9 0,4 6
HOURS

1,i0/11(si.)0 P IIIA i...4.......... SIGN

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NURSING UNIT ROOM NO. BED NO.
1116..........MIMERISHE affilM

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PATIENT IDENTIFICATION IIDATE OF 0 E - TIM r 'I
OF ORDER
Mir , HOURS

Ar.
dill
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LING UNIT ROOM NO. BED NO.

• 0 II_ A -00 =Lei
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PATiFNT IDENTIFICATION DATE OF ORDER
TIM •F ORDER \
KED,l_ LIU -v

0 6-4- 63 HOURS ihe
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REPLACES EDITION OF 1 JUL 77, WHIG
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4256
APR 79

MEDCOM - 18241
(t-
DOD-031815

CLINICAL RECORD • DOCTOR'S ORDERS
For us- -` this form, see AR 40-66, the proponent agency is OTSG
THE DOCTOR SHALL RECORD DATE,
IND

SIGN EACH SET OF ORDERS. IF PROf.
SYSTEM IS USED, WRITE PROBLEM NL ')RIENTED MEDICAL RECORD
IN COLUMN INDICATED BY ARROW BELC
PATIENT IDENTIFICATION

DATE (F ORDER
TIME OF ORDER LIST TIM
ORDER
NOTED AND

6U6 5
HOURS
SIGN

NURSING UNIT

ATE OF ORDER yam^
TIME OF
ORDER
HOURS
NURSING UNIT ROOM NO,
BED
Pa
PATIENT
IOENTIFICATION

DATE OF ORDER
TIME OF ORDER
HOURS

NURSING UNIT
' ROOM NO.
BED NO.

PATIENT IDENTIFICATION
DATE OF ORDER
TIME OF ORDER
HOURS

NURSING UNIT
I 1
ROOM NO.
BED NO.

REPLACES EDITION OF 1 JUL 77, WHICH MAY BE USED.

DA 4256
1 FAOP7:19

MEDCOM - 18242
DOD-031816

CLINICAL RECORD/ THERAPEUTIC DOCUMENTATION CARE P
N (NON-MEDICATION)

For use of this form, see AR 40-40
• Yr. 2003
VERIFY BY INITIALING
INJTL4L PROPER
=MN FOLLOWING LAG! COMPLETION

ORDER CLERK!' RECURRING ACTIONS, DATE COMPLETED
DATE NURSp FREQUENCY, TIME

EralliMENTIMEIPHIR
Z'ack N Po
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ALLERGIES: 0 YES ED NO
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ADDMONAL El YES
D NO PAGE NO:

PATENT IDENTIFICATION:
ACTION TIMES USE PENCIL. CIRCLE ACTION TIMES D
8 9 10\1 12 13 14 15

E
16 17 18 19 20 21 22 23 N 24 01 02 03 04 05 06 07
DA FORM 4677, 1 OCT 78 EDITION OF 1 DEC 77 MAY RF usEn.
USAPA V1 .e0

MEDCOM - 18243
DOD-031817

SINGLE ACTIONS

MIK-4.
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bun
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11111¦1¦1111111111 111111111111111111111111111111111
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b?-') --Z er--\1
CLINICAL RECORD THERAPEUTIC DOCUMENTATION CARE PLAN (NON-MEDIC477011)
For use of this form, see AR 40-407; Is the Office of The Sumeon General,. Mn. Yr. 2003
VERIFY BY INITIALING
INITIAL PROPER COLUMN FOLLOWING EACH COMPLETION
ORDER CLERK/ HR
RECURRING ACTIONS, DATE COMPLETED
DATE NURSE
FREQUENCY. TIME
IIIMMINIERVIMIUMEI tic) Mr
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PAGE NO:

PATIENT IDENTIFICATION:
ACTION TIMES--USE PENCIL. CIRCLE ACTION TIMES 8 9 10 11 12 13 14 15 E 16 17

18 19 20 21 22 23 N 24 01 02 03 04 05 06 07 DA FORM 4677, 1 OCT 78 EDITION OF 1 DEC 77 MAY Rs [Ism,
USAPA V1.00

MEDCOM - 18245
DOD-031819
Verit y by
THERAPEUTIC DOCUMENTATION CARE PLAN

(NON-MEDICA770N)
Order Clerk Yr 2003 Date Nurse
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ACTION, FREQUENCY PROPER COLMAN FOLLOWING COMPLEZION
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USAPA V1.00

MEDCOM - 18246
DOD-031820

CLINICAL RECORD THERAPEUTIC DOCUMENTATION CARE PLAN (NONMEDICATION}
For use of this form, see AR 40-407:
•t! the r Rpnent aoen is the Office of The Surgeon General. Mo. yr. 2003 IMTIAL PROPER COLUMN FOLLOWING
acH COMPLETION

ORDER CLERK/
RECURRING ACTIONS,
DATE NURSE

FREQUENCY, TIME

111101171,1111511121
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LLERGIES:
PRIMARY DIAGNOSIS: AOOMONAL PAGES IN USE:
E3 YES p NO
fla
PAGE NO:

PATIENT IDENTIFICATION:
ACTION TIMES USE PENCIL. CIRCLE ACTION TIMES
D 8 9 10 11 12 13 14 15
E 16 17
18 19 20 21 22 23

N 24 01 02 03 04 05 06 07'

W. FORM 4677, 1 OCT 78 EDITION OF 1 DEC 77 MAY RE USED. USA'A V1.00
MEDCOM - 18247
—
DOD-031821
Verit by Initialing Order Clerk THERAPEUTIC DOCUMENTATION CARE PLAN (NON-MEDICATION)/'. Yr 2003
Date Nurse SINGLE ACTION Date to Time to
be Done be Done Tlfite Done Initials
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Date ACTION. FREQUENCY
TIMFJDATE COMPUTED
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usAPA vt.00

MEDCOM - 18248
DOD-031822

THt EUT1C DOCUMENTATION CARE PLA
CLINICAL RECORD W-MEDICATION)
For use of this form, see AR 40-40.
the proponent agency Is the Office of The Surge.... Ma 0 Yr.
...nerat 2003
VERIFY BY INITIALING
MIIMUMSWASM NOREME

INITIAL PROPER COLUMN FOLLOWING EACH
COMPLETION

ORDER CLERK! HR
RECURRING ACTION, DATE COMPLETEDDATE
NURSE
FREQUENCY, TIME

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ACTION TIMES

• USE PENCIL. CIRCLE ACTION TIMES
D 8 9 10 11 12 13 14 15
E 16 17 18 19 20 21 22 23
N 24 01 02 03 04 05 06 07
DA FORM 4677, 1 OCT 78 EDITION OF t DEC 77 MAY BE USED. USAPA V1.00

MEDCOM - 18249

DOD-031823

Verity by
THERAPEUTIC DOCUMENTATION CARE PLAN
Initialing
( NON-MEDICATTON)
Ma Sif Y r 2003
I

Order Clerk
Date to be Done Time Done Initials

Date Nurse SINGLE ACTIONS Time to
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TIME/DATE COMPLETED
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MEDCOM - 18250 USAPA V1.00
DOD-031824
LcicFilkPEUTIC DOCUMENTATION CARE PLAN (NON-MEDICATIOIV)
CLINICAL RECORD I

For use of this form, see AR 40-407; is the Office of The Suroeon General, -Mo. Yr. 2003
VERIFY BY INITLILING
';'-'013`1:410 r4r-fEE. INITIAL PROPER COLUMN FOLLOWING EACH COMPLETION
ORDER CLERK/ RECURRING ACTIONS, HR DATE COMPLETED DATE NURSE FREQUENCY, TIME
ra
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ALLERGIES: 0YES NO PRIMARY DIAGNOSIS: ADDITIONAL PAGES IN USE: ED YES NO
clks4—ia PAGE NO:
PATIENT IDENTIFICATION:
ACTION TIMES USE PENCIL. CIRCLE ACTION TIMES D 8 9 10 11 12 13 14 15 E 16 17 18 19 20

21 22 23 N 24 01 02 03 04 05 06 07 DA FORM 4677, 1 OCT 78 • EDMION OF 1 DEC 77 MAY RE USED.
USAPA V1.00
MEDCOM - 18251 Y I

DOD-031825
THERAPEUTIC DOCUMENTATION CARE PLAN
(NON-MEDICATION)
Yr 2003

Order Cie*
Date Nurse SINGLE ACTIONS Date to

Time Done Initialsbe Done
crbillos 1_13a
01403
II 03

4pfer.16(c 5e%P(ei
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USAPA V1.00
MEDCOM - 18252

DOD-031826
THE, UTIC

UTIC DOCUMENTATION CARE PLAP
CLINICAL RECORD. I IT -MEDICATION) /
For use of this form, see AR 40-407;... the proponent agency is the Office of The Surgeon —nerai. Mo..Yr. 2003
VERIFY BY INITIALING :;4:00'
709.46002008.g.AMOMREM:

INITIAL PROPER COLUMN FOLLOWING EACH COMPLETION
ORDER cLERKr
RECURRING

DATE trEIMEMMINIMEMSEE
L A

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ALLERGIES: D YES
PRIMARY DIAGNOSIS:
ADDITIONAL PAGES IN USE: DYES ONO

PAGE NO
PATIENT IDENTIFICATION:

3 2 parairAecr,
ACTION TIMES USE PENCIL. CIRCLE ACTION TIMES D 8 9 10 11 12 13 14 15 E 16 17 18 19 20 21 22 23 N 24 01 02 03 04 05 06 07

o FORM 4677, 1 OCT 78 EDITION OF 1 DEC 77 MAY BE USED.
USAPA V1.00
MEDCOM - 18253

DOD-031827
vc.)Vc_.PrA
Verity by
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Initialing
( NON-MEDICATION )
Mo .Yr 2003

Order
Clerk
Date to Time to

Date Nurse SINGLE ACTIONS
Time Done Initials
be Done be Done
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Expir PRN INITIAL PROPER COLUMN FOLLOWING COMPLETION
Date ACTION, FREQUENCY

Nurse

TIME/DATE COMPLETED
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MN WIN MID
MEDCOM - 18254
USAPA V1.00

DOD-031828
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EUTIC DOCUMENTATION CARE PLA
CLINICAL RECORD )N -MEDICATION)
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For use of this form, see AR 40-40 the proponent agency Is the Office of The Surges... general. Mo..Yr. 2003
VERIFY BY INITIALING
ROPRIffigNAIEWIIIWWWWW

, ... ._ . ....-., INITIAL PROPER COLUMN FOLLOWING EACH COMPLETION
ORDER CLERK/ HR

RECURRING ACTION, DATE COMPLETED
DATE NURSE
FREQUENCY, TIME

Elit113111MIES .1)
*-ceew) affiNn. -TorA c\c'NiNivve_t.. 'Fc_12.1 -Vc:: c\A
ALLERGIES: 1=1 YES
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ADDITIONAL PAGES IN USE: =YES riNO
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PAGE NO•
PATIENT IDENTIFICATION:

ACTION TIMES USE PENCIL. CIRCLE ACTION TIMES
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D 8 9 10 11 12 13 14 15 E 16 17 18 19 20 21 22 23 N 24 01 02 03 04 05 06 07

DA FORM 4677, 1 OCT 78 EDITION OF 1 DEC 77 MAY BE USED.
USAPA V1.00
MEDCOM - 18255

DOD-031829
Verity by
THERAPEUTIC DOCUMENTATION CARE PLAN
Initialing
(NON-MEDICATION)
Mn

Order Clerk
Date to Time to

Date Nurse SINGLE ACTIONS
be Done Time Done Initials
be Done
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Clerk/ PRN

Expir INITIAL PROPER COLUMN FOLLOWING COMPLETION Date ACTION, FREQUENCY
Nurse TIME/DATE COMPLETED
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MEDCOM - 18256
USAPA V1.00

DOD-031830
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THE .ZUTIC DOCUMENTATION CARE PLA'
CLINICAL RECORD IN -MEDICATION)
the proponent agency Is the Office of The Surgeon ...eneral. 310. Of-Yr. 2003
VERIFY BY INITIALING

iNNIMMEMEMMitnefifitiEK

INITIAL PROPER COLUMN FOLLOWING EACH COMPLETION
ORDER HR

CLERK/ RECURRING ACTION, DATE COMPLETED
DATE NURSE

FREQUENCY, TIME

IEMPERIPMEINTIMESEI
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ALLERGIES: ED YES NO PRIMARY DIAGNOSIS:
ADDITIONAL PAGES IN USE: I tArotig / rOfq.rat( dihJLi ; 1— ]YES I—I NO
1Pfi th( PAGE NO' PATIENT IDENTIFICATION:
ACTION TIMES USE PENCIL. CIRCLE ACTION TIMES
D 8 9 10 11 12 13 14 15,
E 16 17 18 19 20 21 22 23
N 24 01 02 03 04 05 06 07

DA FORM 4677, 1 OCT 78 EDITION OF 1 DEC 77 MAY BE USED.
USAFA V1.04;
MEDCOM - 18257

DOD-031831
Verity by THERAPEUTIC DOCUMENTATION CARE PLAN Initialing ( NON-MEDICATION) Ain. Yr.2003
Order Clerk
Date to Time to

Date Nurse SINGLE ACTIONS Time Done Initials
be Done be Done

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DOD-031832
THE .UTIC DOCUMENTATION CARE PLAI V -MEDICATION)
CLINICAL RECORD For use of this form. see AR 40-407; 0
the proponent agency Is the Office of The Surgeon s,eneral. MO..yr. 2003 VERIFY BY INITIALING ,t..A.:m . It w ,--. ,-,3 . '.."na .'‘ INITL4L PROPER COLUMN FOLLOWING EACH COMPLETION
HR DATE COMPLETED -
ORDER CLERK) RECURRING ACTION,
DATE NURSE FREQUENCY, TIME

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MEDCOM - 18259

DOD-031833
b (Co) -\

THE, DTIC DOCS MENTATION CARE PLAT V -MEDICATION )
CLINICAL RECORD
For use of this form. see AR 40-407: the proponent agency Is the Office of The Surgeon c,eneral. Mo.Yr. 2003
2'1ZIFY BY INITIALING ::;-,FIA jd' :-:. , -
INITIAL PROPER COLUMN FOLLOWING EACH COMPLETION
ORDER CLERK/ RECURRING ACTION HR DATE COMPLETED DATE NURSE FREQUENCY, TIM
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Mo /1/) i 2003
the proponent agency Is the Office of The Surge.— ..eneral.
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HR DATE COMPLETED
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D 8 9 10 11 12 13 14' 15

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, 1 OCT 78 USAPA V1.00
MEDCOM — 18261

DOD-031835
Verity by THERAPEUTIC DOCUMENTATION CARE PLAN di/
Initialing (NON-AfEDICARON) Ma Q yr. 2003

Order Clerk Date to Time to
SINGLE ACTIONS Time Done Initials
Date Nurse be Done be Done
(t)., Vy 76)
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MEDCOM -18262 1
USAPA V1.00

DOD-031836
THERAPEUTIC DOCUMENTATION CARE PLAN (MEDICATIONS)
CLINICAL RECORD For use of this form, see AR 40407:
the nr000nent aaenc is the Office of The Surgeon General.

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