Medical Report: 25-Year-Old Iraqi Male, Detainee, Abu Ghraib Prison, Baghdad, Iraq re: Gunshot Wounds to Leg and Shrapnel to Arm

RECORD-SUPPLEMENTAL MEi DATA W
For use of rm, see AR 40-66; the proponent agency is the Offic The Surgeon General. OTSG APPROVED (Date) REPORT TITLE
QA Appr 8 Mar 89
— .. — ,_ _ . _
SHIFT ASSESSMENT )-
INITIALS:TIME:
TIME: VCi i (t INITIAL N
U EXTREMITY MOVEMENT vl /-:KrI 41',. ( .. .r iftirt----r-e-i 12_t. (l 67)
-'1.• - C 1 01.,51
SEDATION V '
PAIN CONTROL 11230 a ..54-1\./ rt. ,--.- i Y;,_ ¦ r7.cf;,;'?-fir.., 1
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* RESPIRATORY PATTERN f.,11.p.ic-,.i_.fro,La I c ivni--4---i-A-E BREATH SOUNDS ,,,:::7", r'.7. -4-1,!.k.-:./.f,'W.0-...,..„.÷-,§ SECRETIONS
' 02 SOURCE/FLOW/SAO2
VENTILATOR SETTINGS

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#2 TYPE/LOCATION/SIZE
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IV FLUIDS/RATE 'c.'

DATE
PREPARED BY (Signature & Title)
lq5e1-1---2_
PATIENT'S IDENTIFICATION (For typed or written entries give: Name —last,
first, middle; grade; date; hospital or medical facility) HISTORY /PHYSICAL . FLOW CHART

.
NAME: RANK: AGE:
. OTHER EXAMINATION ¦ OTHER (Specify)
UNIT: GENDER: /Li OR EVALUATION
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STATUS: US: AD / CIV IRAQI: CIV / (EPW
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USAPPC V2.00
MEDCOM - 18641
DOD-032215
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MEDCOM - 18642
DOD-032216

. MTF LOCATION
1. REPORTING MTF ADMISSION AND CODING INFORMATION
For use of this 101711, see AR 40-400; the proponent agency is OTSG
4. PAY GRADE . SEX
. REGISTER NUMBER
RELIGION
9- ETHNIC
AGE AT ADMISSION

6. DATE OF BIRTH IYYYYMMOD) 7. BACK­
19 20 21.22.23 24 25.26
GROUND

10. LENGTH OF SERVICE HOUR OF
13. MARITAL STATUS ADMISSION

ORGANIZATION lAclive Duty Only.?
16. ZIP CODE OF RESIDENCE
15. BENEFICIARY CATEGORY 53 54 55 56 57 58 59 60 14. FLYING STATUS PREY. ADMISSION
19. TRAUMA

17. UNIT LOCATION 'State or 18. MOS
Country Code) YEAR
62 63

NAME/RELATIONSHIP OF EMERGENCY ADDRESSEE
20. OURCE OF ADMISSION/ AUTHORITY FOR WARD
ADMISSION

ADDRESS OF EMERGENCY AL2RESSEE /Include OP Code)
) I Cu-
TELEPHONE NUMBER OF EMERGENCY ADDRESSEE
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23. DATE OF DI P0522. MTF TRANSFERRED TO

21, T.OF DISPO
76 77 78 79 80

73 26. DATE THIS ADMISSION (V YMMDD,I
25. PATF TRANSFERRED FROM
24. CLINIC SVC • ADMITTING
29. DATE INITIAL ADMISSION !Y Y MMD 01
28. MTF OF INITIAL ADMISSION27. LOCATION OF OCCURRENCE
.!Bank. Casualty Only)
103 • 104.

SIGNATURE OF ADMITTING CLERK

ADMITTING 0
USAPPCV1.0
DA F 89 MEDCOM - 18643
DOD-032217

INPATIENT TREATMENT RECORD COVER SHEET
For use of this form, see AR 40.400; the proponent agency is OTSG
3. GRADE2. NAME Dart, Rr01, ALDREGISTER NUMBER

ofvx. -AI A 01 I= Ci V
4. SEX 5. RACE 7 RELIGION 8. LENGTH C 9 ETS 10 PREVIOUS ADMISSION
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25. TYPE DISPOSITION 28. DATE OF DtPOSITION

20 NAME/RELATIONSHIP OF EMERGENCY ADDRESSEE
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2h. ADDRESS OF EMERGENCY ADDRESSEE Onclud. IIP Cade)
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30. DATE OF
gui

29 NAME AND LOCATION OF MEDICAL TREATMENT FACILITY ADMISSION
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33. CAUSE OF INJURY
34 DIAGNOSESIOPERATIONS AND SPECIAL PROCEDURES
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k. e. d. SUPPLEMENTAL e, BEG DAYS
I

a. ABSENT SICK DAYS OTHER DAYS CONY. LVICOOP CARE DAYS CARE DAYS
a 86,
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36. Total Days All Facilites
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SUPPLEMENTAL BED DAYS CARE DAYS CARE DAYS ...6jiminimimmil6;

e. ABSENT SICK DAYS b. OTHER DAYS CONY. LYICDOP d. e.
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ADMISSION REMARKS
ADMITTING OFFICER
32. UNITS OF WHOLE BLOOM COMPONENT TRANSFUSED
Check LI Catmint! en Reverse
I, TOTAL SICK DAYS
36
L TOTAL SICK DAYS -5

G _
SIGNATURE OF ATTENDING MEDICAL OFFICER
MEDCOM -
DOD-032218

ABBREVIATED MEDICAL RECORD
MEDICAL
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PERTINENT HISTORY, CHIEF COMPLAINT, AND CONDITIOAN ADMISSION (Enter date of admission)
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ABBREVIATED MEDICAL RECORD Standard Form 539
MEDCOM - 18645 GENERAL SERVICES ADMINISTRATION AND INTERAGENCY COMMITTEE ON MEDICAL RECORDS FIRMR (41 CFR) 201-45.505 OCTOBER 1975 USAPPC V1.00
DOD-032219

NSh 7540-00-634-4176 AUTHORIZED FOR LOCAL REPRODUCTION
I
CHRONOLOGICAL RECORD OF MEDICAL CAREMEDICAL RECORD
SYMPTONS, DIAGNOSIS, TREATMENT, TREATING ORGANIZATION (Sign each entry)
DATE
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SPONSOR'S NAME SSNAD NO. RELATIONSHIP TO SPONSOR
REGISTER NO. WARD NO.
PATIENT'S IDENTIFICATION: (For typed or written entries, give: Name - last, first, middle; ID No or SSN; Sex:
Date of Birth; Rank/Grade.)
CHRONOLOGICAL RECORD OF MEDICAL CARE Medical Record
STANDARD FORM 600 (REV. 6-97)Prescribed by GSAACTAR FIRMR (41 CFR) 201-9.202-1
MEDCOM 18646
-
DOD-032220

AUTHORIZED FOR LOCAL REPRODUCTION

CHRONOLOGICAL RECORD OF MEDICAL CARE
MEDICAL RECORD
tory', G cm I cr 11r y/
SYMPTOMS, DIAGNOSIS, TREATMENT, I Kt/A I !NU UM-3/.4\11Z" 1 I l.J14
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CHRONOLOGICAL RECORD OF MEDICAL CARE
Medical Record STANDARD FORM 600 (REV. 6-97) Prescribed by GSA/ICMR
USAPA V2 00
FIRMR (41 CFR) 201-9.202-1
MEDCOM - 18647
DOD-032221
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^AUTHORIZED FOR LOCAL REPRODUCTION
CHRONOLOGICAL RECORD OF MEDICAL CAREMEDICAL RECORD I
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PATIENTS IDENTIFICATION: of Birth; Rank/Grade.)
CHRONOLOGICAL RECORD OF MEDICAL CARE
Medical Record STANDARD FORM 600 (REV. 6-97) Prescribed by GSA/ICMR
USAPA V2.00
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MEDCOM - 18648
DOD-032222

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DOD-032223

PROGRESS NOTES
MEDICAL RECORD
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REGISTER NO.
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PATIENT'S IDENTIFICATION
PROGRESS NOTES
Medical Record
STANDARD FORM 509 IREV. 7911 Prescribed by GSAIICMR. FIRMR 141
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MEDCOM - 18650

DOD-032224

PROGRESS NOTES

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MEDCOM - 18651
DOD-032225

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MEDCOM - 18652
DOD-032226
AUTHORIZED FOR LOCAL REPRODUCTION
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NOTES

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PROGROS NOTES ,
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Medic . . STANDARD FORM 409 (REV. 5/1999)
Prescribed by GSA/ICMR FPMR (41CFR)101-11203(b)(10) USAPA V1 00
MEDCOM - 18653
DOD-032227

AUTHORIZED FOR LOCAL REPRODUCTION
PROGRESS NOTESMEDICAL RECORD
NOTESDATE
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PROGRESS NOTES
Medical Record
STANDARD FORM 509 (REV. 5/1999)
Prescribed by GSA/ICMR FPMR (41CFR) 101-11.203(b)(10)
USAPA v1.00

MEDCOM - 18654
DOD-032228
LAST NAME FIRST NAME
MIDDLE INITIAL ID NUMBER
DATE
NOTES
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STANDARD FORM 509 (REV. 5/1999I BACK USAPA v1.00
MEDCOM - 18655
DOD-032229
NSN 7540-00-634-4176 AUTHORIZED FOR LOCAL REPRODUCTION
CHRONOLOGICAL RECORD OF MEDICAL CARE
MEDICAL RECORD
DATE SYMPTONS, DIAGNOSIS, TREATMENT, TREATING ORGANIZATION (Sign each entry)
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