Medical Report: 27-Year-Old Iraqi Male, Detainee, Baghdad, Iraq re: Multiple Gunshot Wounds to Chest, Torso and Abdomen

MEDICATIONS Allergies: Time Pain Medication 8 Route Pain I/E By 1-10 Dosane 1-10
ofp
6S07-3 oz-ii-kkt.seaCY.A ..1--Nrx\
NEUROVASCULAR
Time Site ' Range Sensory P Cap T Color
Of Refill
Motion
Mm -c-Vki., \)\--th \ 3cc - \ A-me_...z). ‘A.) -.F.,
15'
30'
45'
60'
90'
DIC

Movement/Sensation: + = present,- = absent Temp:C = Cool,
-W =Warm Pulses: P= Palpable, D = Doppler, A= Absent
Color: C = Cyanotic, . Capillary Refill: B.= Brisk, S= S uggish P= Pale, Pk = Pink
-....._ C-SECTIONS Adm 15' 30' 45' 60' ' D/C
---________::__Fund. Height
---..................„

Lochia Peripad# Fund. Cond.
DRESSINGS Location Type Drainage
Time
Adm Aslc al-.s5 • is1.-0.
30' .-60' (T) 1I eL a i\lf-t 11 5\ tpl uit.43:.--4-;1) ° NPA) Gka -r4147.0-Ans&-K,Rqd.-
PACU OUTPUT
Time Source or/Appearance Amount
CARDIAC RHYTHM Time Rhythm Symptomatic? Rhythm Strip Run?
04' '1', .. bsg....,---€3-•
NURSING NOTES
t-,\. ¦ c.,\ •v ' r cc_ I .ik., iN• k
0\-L---k•ci\f--..(- • Pi- cov\hc-.4\\)3L_. . Gc--,k\ c.."--03cA si r\ i:A4-U_ - O ‘1 c Ci. ----e- 10 u- pc--ovA-L.L _ v SS _ Pc--c t r) 7:c_s-hc_411--ks
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-
-
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Dye INIMUNINI
. NEVISINI
LAREMVANUIPI
oggrai

malyAL
Discharge Criteria:
Date:I(3 sq)03ime: PARS:
BP: \ T: HR: 11 RR: 14,ssa02:q61-

Pain Le I at. 9/c (0-10):
Intake: L-1-60

Output: tb Additional Datatel-Transferred To: (C. vJ .4--Report Given To: Transferred Via: W/ . nce
•
Transferred By: QP Cleared IAW Recovery R Charge Nurse Signature:
CP-T

WAMC OP 173-E
MEDCOM - 18841
1) ((a) -L
DOD-032415
•

MEDICAL RECORD -SUPPLEMENTAL MEDICAL DATA use of this form see 40-66: the proponent agency is the Office of the Surgeon General
FLOWSHEET I OTSG APPROVED (Date)
INITIAL ASSESSMENT ill IMMEDIATE • DELAYED U MINIMAL
.
nr--)-5r--,
Date: 1:1 Arrival Time: .....---1).Sex: 0 F Age: a•••—/ Wt: /11-7(•-•
50 P )rt-Tetanus Status: UTDa'S-Unknown
Allergies:
Last Meal: JA,.4) 7.--... Chief Complaint:
LMP:
Medicatior
PMH:
Treatments PTA:
.---0--, . VITAL SIGNS: (5.0 6.5 BP: ,; P: ) c)— RR: / -...3 TEMP: SA02: ,/ i-
CHEST SXIN ABDOMEN NEURO n
TRAUMA YES — NO — WARM 111OFT PERRL ES . NO R nun L mm PAIN YES — NO — DRY IS'TENDED GLASGOW SCORE i --
PA
/
SOB YES "- NO — PALE 1 e.NDER LUNG SOUNDS USKY' BOWEL SOUNDS R L — MOIS YES .NO PUPIL
—
Ni 0 — GULATEST SIM 2 - 3 • 4 • 5 • 6 • 7 • 8
lo CLEAR • 9
• . WHEEZES • POS . NEG • • DECRESED• • ABSENT 1. EYE OPENING 2. VERBAL REPONSE 3. MOTOR REPONSE
Spontaneous 4 Oriented 5 Obedient 6
To Voices 3 Confused 4 Prostrated 5 •••¦ /ES To Pain 2 Inappropriate 3 Withdrawal 4 EMIT mPULSES None Incomprehensible 2 3
ilISTAL ?C :5 I Flextion ' • T X2 L .1 'None 1 Extension 2II • • v EXTREMITIES X4,. ) None I
N .--CrEMENT, plio.n.11111Man IIACX .1.4ft
"
nis NO DEFORMITIES EXCEPTIONS TO A= Abrasion ABOVE SPLINTS AP=Amputation PARAMETERS: ^;^AV=Aversion
, ... 0.
(5'

TREATMENTS: B=Bum
02: LPM NC MASK ORAL AIRWAY . . A C=Contusion ETT • MM. n NASAL AIRWAY A D=Deformity MONITOR Y—' N EKG .ff . N E=Extension NG TUBE • e.F=Open Fracture
...¦ ..--,
FOLEY: • DPL mi POJ NEG LZ/ ---CF=Closed Fracture CHEST TUBE R • L CM H2O G=GSW L=Laceration
-2-
PW=Puncture
Z.-
Ad ition I Into entions/Assessments )31-1-1--/b./1.? 171;:v4__ Wound S=Stab Wound
. -4... ,,
O=Other .: 4 6 z":: dcd-tt9--k
PATIENT'S IDENTIFICATION For typed or written entries
give: Nante-last; first; mi.. • • HISTORY/PHYSICAL I FLOW CHART
facility)
Patient/Soldier's Name: U OTHER EXAMINATION . OTHER (Specify)

imormitorrit OR EVALUATION
• DIAGNOSTIC STUDIES
Rank:
SSN: / / DOB: /2/ 7//7X

U TREATMENT DA FORM 4700
•

MEDCOM - 18842
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1.EPORTINGNITF .. _ I - . MTF LOCATION - - -,-ADM;SSION AND CODING INFORMATION
1 2 2.14 5 5 7 (State of

Country
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For .mo of :41.1 form, see AR4C1400; the proponent agency is OTSG
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3..REGISTER NUMBER NAME (Last, first, Middle In dal) 4. PAY GRACE E.. SEX
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6..DATE OF BIRTH (Yr YYMMOD) 7. AGE AT ADMISSION 8. RACE S. ETHNIC RELIGION
19 20 21 22 23 24 25 26 27 28s29 311171
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10..LENGTH OF SERVICE ETS 11..FMP Li 12. SOCIAL SECURITY NUMBER
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ORGANIZATION (Active Duty Only) 13..MARITAL STATUS HOUR OF BR ADMISSION 10 ( C3 ---rti
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14. FLYING STATUS 15. BENEFICIARY CATEGORY 16. ZIP CODE OF RESIDENCE
47 48 49 50 52 54 56 58
51 53 55 57 59 60 61 \— ---7
17. UNIT LOCATION (State or 18. MOS
19. TRAUMA PREV. ADMISSION
Country Code)
62 63 64 65 66 67 68 69 70 71 YEAR
Fi C
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20. SOURCE OF ADMISSION/ AUTHORITY FOR WARD NAMEIRELATIONSHIP OF EMERGENCY ADDRESSEE
ADMISSION

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ADDRESS OF EMERGENCY ADDRESSEE (Include ZIP Code)

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TELEPHONE NUMBER OF EMERGENCY ADDRESSEE b CO — (--
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21. TYPE OF DISPOSITION 22. MTF TRANSFERRED TO 23. DATE OF DISPOSITION IrYYYMM001
73 74 75 / 76 77 78 79 BO 81 82 83 84 85 86
c---0 o 0 g aL
24. CLINIC SVC - ADMITTING 25. MTF TRANSFERRED FROM 26. DATE THIS ADMISSION tY Y Y YMMD01
89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106
i e-inn
• iMIN o WM .1
27..L OCATION OF OCCURRENCE 28. MTF OF INITIAL ADMISSION 29. DATE INITIAL ADMISSION (Y Y r r M M 0 Ol (Battle Casualty Only)
I I

107 108 109 110 111 112 113 '114 115 116 117 fs118 119 120s121sIs122
FOR LOCAL USE
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DOD-032417
1. REPORTING MTF 2. MTF LOCATION
ADMISSION AND CODING INFORMATION
1 2 3 4 5 6 7 8 I.Srare or Country
For use of this form, see AR 40-400: the proponent agency is OTSG
Code.)
3. REGISTER NUMBER NAME (last, First, Middle Initial)
4. PAY GRADE 5. SEX 9 10 11 12 13 14 ;;15
16 17 18
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6. DATE OF BIRTH (Y Y Y YMMODI 7.
AGE AT ADMISSION 8. RACE 9.
ETHNIC RELIGION
19 20 21 22 23 24 25 26 27 28 29 30

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10. LENGTH OF SERVICE ETS 11. FMP
12. SOCIAL SECURITY NUMBER
32 • 33 35 36 37

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9 `i
ORGANIZATION (Active Duty Only) 13. MARITAL STATUS
HOUR OF BRANCH! CORPS ‘,.. ADMISSION
46
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14. FLYING STATUS 16. BENEFICIARY CATEGORY
16. ZIP CODE OF RESIDENCE
47 48 49 50 51 52 53 54 55 56 57 58 59 60 61
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17. UNIT LOCATION (State or 62 63 Country Code) 18. MOS 64 65 66 67 68 69 70 19. TRAUMA 71 PREY. ADMISSION YEAR 47c. NO
/
20. SOURCE Of ADMISSION/ AUTHORITY FOR WARD NAME/RELATIONSHIP OF EMERGENCY ADDRESSEE
ADMISSION _
72
e JCI„/ ADDRESS OF EMERGENCY ADDRESSEE (Include DP Code) ,( ,)_, TELEPHONE NUMBER OF EMERGENCY ADDRESSEE

. ,
21. 22. MTF T A RRED TO 23. DATE OF DISPOSITION (i' Y M M 0 D) 73 74 175 76 77 78 79 80
81 82 83 84 85 86
0 -.0 0 3 0 9' a .2
24.sCLINIC SVC • ADMITTING 25. MTF TRANSFERRED FROM 26. DATE THIS ADMISSION (Y YMMDD)
87
88 89 90 91 92 93 94 95 96 97 98 99 100 101 102
03 0 9 /

27. LOCATION OF OCCURRENCE 28. MTF OF INITIAL ADMISSION
29. DATE INITIAL ADMISSION (V V
A/ MO DI
Merle Casualty Only)
103 104 105 106 107 108 109 110 111 112 113 114 115 116
FOR LOCAL USE
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DOD-032418
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ATIENT TREATMENT RECORD COVER s-ETs-
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For use of this form, see AR 40-400; the proponent agency is OTSG
1.sREGISTER NUMBER 3.sGRADE ADMISSION REMARKS
C.--...-
la.sSEXs5.sAGE 6sRACE 10.sPREVIOUS
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15.sFLYING 16 8.sBRANCH/COR S 19.sUIC/ZIP 20.sTYPE CASE
STATUS D BEN
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21.sSOURCE OF ADMISSION/AUTHORITY FOR ADMISSI• 22.sHOURS OF 23.sCLINIC SERVICE
ADMISSION

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24.sNAME/RELATIONSHIP OF EMERGENCY ADDRESSEE :Er'sTYPE DISPOSITION 26.sDATE vF DISPOSITIONs
\S...., ....CL¦._\
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27a.sADDRESS OF EMERGENCY AMR -.S Include ZIP Code) 27b.sTELEPHONE NO. 28.sDATE OF THIS ADMITTING OFFICER ADMISSION
' T EATME sFACT 30.sDATE OF INTIAL 32.sUNITS OF WHOLE BLOOD/ ADMISSION COMPONENT TRANSFUSED
TIVE DATA I
I(D ( '2.) Z-----
Check if Continued on Reverse
33.
CAUSE OF INJURY

34.
DIAGNOSES/OPERATIONS AND SPECIAL PROCEDURES

\
ISL
35. Total Days This Facility
a.sABSENTSsK DAYS b.sOTHEsDAYS f c.sCsV/COOP d.sSUPPLEMss TAL BED DAYS TOTAL SICK DAYS
VAs
• YS
........„.

36..Total Days All Facilites
I
a..ABSENT SICK DAYSs1b.sOTHER DAYSs: c.sCOW. LV/COOPsd.sSUPPLEMENTAL e.sBED DAYS i I.sTOTAL SICK DAYS
IsCARE DAYSs CARE DAYS
_ ,;s•
Is
\ •
SIGNATUs RICERs ' ER

DA FOs RI f1C •__AtsC rlGrIle-re -
MEDCOM - 18845
DOD-032419
---,..—............-
1 .sREPORTING MTF 2.sMTF LOCATIONs
-
ADMISSION AND CODING INFORMATION
-
1 2 3 4 5 6 7 8 (Stat.? or
Country -s

:,=.,* ---- Fer .ise or this form, see AR 40-400; the proponent agency is OTSG s-
A I \sL._‘_,_c.: Code.)
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3.sREGISTER NUMBER NAME (Last, Bret, Middle Initial; ¦00 o) 4.sPAY GRADE 5.sSEX
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9s10s11s12s13 14
16 17 18
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6.sDATE OF BIRTH (V Y Y YMMDD) AT ADMISSION 8.sRACE 9.sETHNIC RELIGION
19 20 21 22 23 24 25 26 27 28 29 30 31
BAC K-10 GROUND
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10.sLENGTH OF SERVICE ETS
11.sFMP I 12.sSOCIAL SECURITY NUMBER 32 33 34 35 36 F1111111111rMINUMIIIIIPMPWIIIINi
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ORGANIZATION (Active Duty Only 13. MARITAL STATUS • PS
ADMISSION
46 N/ \
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14.sFLYING STATUS 15.sBENEFICIARY CATEGORY 16.sZIP CODE OF RESIDENCE
47 48 49 50 51 52 53 54 55 56 57 58 59 60 61
•,..
17.sUNIT LOCATION /State or 18.sMOS 19. TRAUMA PREY. ADMISSION
Country Code)

62 63 64 65 66 67 68 69 70 71 YEAR
NO
4C27.

NAME/RE.....,....1......,....
Is. .........!s

20.sSOURCE OF ADMISSION! AUTHORITY FOR WARD EsRGENCY ADDRESSEE
ADMISSION
72
ADDRESS NF EMEMsCsD RESSEE (Include ZIP Code)
tr.,( -6.

... ..
Ala
TELEPHONE N MBE' •sCY ADDRESSEE
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21.s- • - •s¦ y— 23.sDATE OF DISPOSITION (Y Y Y YMMD0)
73 74 79 80 81 82 83 84 85 86 87 88
75 kit domain 01.t_—
S--C ¦ l111LOSIUM \ M
24.sCLINIC SVC . ADMITTING 25. MTF TRANSFERRED FROM 26.sDATE THIS ADMISSION (Y Y Y YMMD0)
89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106
bg...E41...Ik.Ig A PLUI1 LaillWrilliaPla ell?
2 . LOCATION OF OCCURRENCE 28.sMTF OF INITIAL ADMISSION 29.sDATE INITIAL ADMISSION (YYYYMMD0)
(Battle Casualty Only)

107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122
FOR LOCAL USE
(......\
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---A DTAITEEN 9 OFFICER (Si :s required)
)
MEDCOM - 18846
DOD-032420

INPATIENT TREATMENT RECORD COVER SHEET
For use of this form, see AR 40.400; the proponent agency is OTSG
(Last, first, MI) (...... 3.sGRADE ADMISSION REMARKS
2.sNAMEs
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buss c s-N...1
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BRANCHICORPS 19.sUICIZIP 20.sTYPE CASE STATUSs BEN 15.sFLYINGs18.s
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22.sHOURS OF 23.sCLINIC SERVICE ADMISSION21.sSOURCE OF ADMISSIONIALITHORITY FOR ADMISSION
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25.sTYPE DISPOSITION 28.sDATE OFsISPOSVION24.sNAMEIRELATIONSHIP OF EMERGENCY ADDRESSEE
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28.sOATS OF THIS ADMISSION
27a.sADDRESS OF EMERGENCY ADDRESSEE (Include ZIP Code) 276.sTELEPHONE NO.
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30.sDATE OF INTIAL 32.s29.sNAME AND LOCATION OF MEDICAL TREATMENT FACILITY
ADMISSION COMPONENT TRANSFUSED
c:1___.s--- Z_____ q ( I 1 I 0 'D
31.
Chock if Continued on Ravine
33.
CAUSE OF INJURY .

34.
DIAGNOSESIOPERATIONS AND SPECIAL PROCEDURES

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35. Total Days This Facility
a.sABSENT SICK DAYS t: b.sOTHER DAYS 0 c.sCONY. LV/COOP CARE DAYS 0 d.sSUPPLEMENTAL CARE DAYS CD e.sBED DAYS 3 eg--- I.sTOTAL SICK DAYS_,..._as.J
35. Total Days All Facilites ..
a.sABSENT SICK DAYS b.s1 Hy.. TS-(4 D C.sCONY. LVICOOP CARE DAYS C--) d.sSUPPLEMENTAL CARE DAYS C) S. f3E0 OATS ..5___,;,_ EsTOTAL SICK DAYS s-a.
SIGNATU SIGNATURE OF PAD OR MEDICAL RECORDS OFFICER

MEDCOM - 18847
nn Cna RA 1R liCAPICIft le
DOD-032421
. . _
MEDICAL RECORD ABBREVIATED MEDICAL RECORD
PERTINENT HISTORY, CHIEF COMPLAINT, AND CONDITION ON ADMISSION (Enter date of admission)
It4fr,SA ,
2-9 s
Nosmoo

.
PHYSICAL EXAMINATION
I
PROGRESS (Enter date of discharge and final diagnosis)
eJ
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SIGN DATE... IDENTIFICATION NO. ORGANIZATION .
.--.-I
PATIENT'S I !CATION (For ryped or written entries give Name last, first, REGISTER NO. WARD NO.
middle; grade; date; hospital or medical facility)
ABBREVIATED MEDICAL RECORD
Standard Form 539
GENERAL SERVICES ADMINISTRATION AND
INTERAGENCY COMMITTEE ON MEDICAL RECORDS
FIRMA 141 CFR) 201-45.505
OCTOBER 1975
MEDCOM - 18848 USAPPC VI.00

DOD-032422

ABBREVIATED MEDICAL RECORD -
MEDICAL RECORD
MYL tNr ANC CON iO.- CN ACM t5SION ,
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MEDCOM - 18849
DOD-032423

AUTHORIZED FOR LOCAL REPRODUCTION
''-11/1EDICAL RECORD CHRONOLOGICAL RECORD OF MEDICAL. CARE
DATE SYMPTOMS, DIAGNOSIS, TREATMENT, TREATING ORGANIZATION (Sign each entry)
ANL-SEP 1 1 2003 GS* qtrTt.ideft.41a ,it) stit_s _ Of-.t--c­sijr . kafreiTAa k 9' , "s.s alesmart Hi 44.-_,:;. aC
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SPONSOR'S NAME SSN/ID NO.s' RELATIONSHIP TO SPONSOR
PATIENT'S IDENTIFICATION: (For typed or written entries, give. Name - last, first, middle; ID No or SSN; Sex; RE GISTER NO.s WAR D NO. Date of Birth; Rank/Grade.)
j'CHRONOLOGICAL RECORD OF MEDICAL CARE
'Medical Record
STANDARD FORM 600 (REV. 6-97) Prescribed by GSA/ICMR FIRMR (41 CFR) 201-9.202-1
MEDCOM - 18850
DOD-032424
DATE SYMPTOMS, DIAGNOSIS, TREATMENT, TREATING ORGANIZATION (Sign each entry)
011,
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STANDARD FORM 600 (REV. 6-97) BACK
USAPA V2.00
MEDCOM - 18851
DOD-032425
NSN 7540-00-634-4176
AUTHORIZED FOR LOCAL REPRODUCTION
MEDICAL RECORD CHRONOLOGICAL RECORD OF MEDICAL CARE
DATE SYMPTONS, DIAGNOSIS, TREATMENT, TREATING ORGANIZATION (Sign each entry)
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SPONSOR'S NAME SSN/ID 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.)
47t
CHRONOLOGICAL RECORD OF MEDICAL CARE
Medical Record
STANDARD FORM 600 (REV. 6-97) Prescribed by GSA/ICMR FIRMR (41 CFR) 201-9.202-1
MEDCOM - 18852
DOD-032426
PROGRESS NOTESMEDICAL RECORD
DATE
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MEDCOM - 18853
DOD-032427

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MEDCOM - 18857
DOD-032431

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MEDCOM - 18858
DOD-032432
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MEDCOM - 18859
DOD-032433

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DATE NOTES
MEDCOM - 18860
STANDARD FORM 509 IREV. 5119991 BACK
USAPA VI .00
DOD-032434

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MEDCOM - 18861
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DOD-032437
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MEDCOM - 18864
DOD-032438
LAST NAME FIRST NAME MIDDLE INITIAL ID NUMBER
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MEDCOM - 18865
DOD-032439

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MEDCOM - 18866
DOD-032440

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MEDCOM - 18867
DOD-032441

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MEDCOM - 18868
DOD-032442
NSN 7610-00434-417e
AUTHORIZED FOR LOCAL REPRODUCTION
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MEDCOM - 18869
DOD-032443
DATE SYMPTOMS, DIAGNOSIS, TREATMENT TREATING ORGANIZATION (Sign each entry)
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MEDCOM -18870
DOD-032444

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STANDARD FORM 509 MEV. 5110981 Presented by GSAIICMR FPMR I4ICFRI 101-11.2031b)(113 USAPA V1.00
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MEDCOM - 18871
DOD-032445

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MEDCOM - 18872
DOD-032446

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STANDARD FORM 509 IREV. EI190BI Prescribed by GSAIICMR FMB 141 CFRI 1111-11.20301110I USAPA VI.00
MEDCOM - 18873
DOD-032447

LAST NAME FIRST NAME MIDDLE INITIAL ID NUMBER
DATE NOTES
MEDCOM -18874
DOD-032448

AunmRlZED FOR LOCAL REI'IIlIDIICTllI
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SPONSOR'S NAME
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STANDARD FORM 509IREV.611999\
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MEDCOM -18875
DOD-032449

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MEDCOM - 18878
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MEDCOM - 18879
DOD-032453

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