Medical Report: 40-Year-Old Iraqi Male, Detainee, Abu Ghraib Prison, Baghdad, Iraq re: Blast Wounds to Chest, Arm and Knee

Medical records of Iraqi detainee, confirmed to be an Enemy Prisoner of War (EPW). Medical conditions included, gunshot wound to the right knee, causing a fracture and a concussion. The additional reports in the record state that the detainee suffered from blast injuries that caused chest, and arm injuries. Shrapnel wounds to the neck and back are also present. The medical records do not state how the detainee received his injuries and does not give any personal information on the detainee.

Doc_type: 
Medical
Doc_date: 
Friday, April 18, 2003
Doc_rel_date: 
Wednesday, June 15, 2005
Doc_text: 

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MEDICATION ADMINISTRATION RECORDMEDICAL RECORD
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MEDCOM - 5401
DOD 12613

PATIENT PROFILE
NAVMED 6550/12 (5-80) S/N 0105-LP-206-5560 DATE V?BATH DATE DIET DATE V VITAL SIGNS F.REGI V SPECIAL NOTES
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DOD 12615
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DOD 12616

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MEDCOM - 5406
DOD 12618

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MEDI{AL RECORD PROGRESS NOTES
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MEDCOM - 5412
DOD 12624

PROGRESS NOTES
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MEDCOM - 5413
DOD 12625

PROGRESS NOTES
MEDICAL RECORD
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PROGRESS NOTES
STANDARD FORM SOO (Rev. 11-77) Prescribed by GSA/ICIAR,
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MEDCOM - 5414
DOD 12626

PROGRESS NOTES
DATE
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M EDCOM - 5415
DOD 12627

PROGRESS NOTES
MEDICAL RECORD
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(b)(6)-4 PROGRESS NOTES
STANDARDFORM 509 (Rw. 11-77) Rooted 4 GSA/D46. MIR (41 CM) 101-11.806-8 509-110
MEDCOM -5416
DOD 12628

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MEDCOM -5417
DOD 12629

MEDICAL RECORD PROGRESS NOTES , ,
DATE I ,,41
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PROGRESS NOTES
STANDARD FORM 509 (Rev. 11-77) Presated by GSA/ICHR.
FPMR (41 CR) 101-11.8064 509-110
MEDCOM- 5418
DOD 12630

PROGRESS NOTES
DATE
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MEDCOM - 5419
DOD 12631
PROGRESS NOTES
DATE
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rb)(6)-4
M EDCOM - 5420

DOD 12632

MEDICAL RECORD PROGRESS NOTES
DATE
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PROGRESS NOTES
STANDARD FORM 509 (Rev. 11-77)
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MEDCOM - 5421
DOD 12633
MEDICAL RECORD4I4 PROGRESS NOTES
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STANDARD FORM 509 (Rev. 11-77)
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FIRMR (41 FR) 201-45.505 509-111
M EDCOM - 5422
DOD 12634

PROGRESS NOTES
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MEDCOM -5423
DOD 12635

PROGRESS NOTES
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DOD 12636
MEDICAL RECORD PR OG4SS NOTES
DATE C
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PROGRESS NOTES
STANDARD FORM 509 (Rev. 11-n) Prescribed by GSA/1CMR, FIRMS 141 CFR) 201-45.505 509-111

MEDCOM - 5425
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M EDCOM - 5426
DOD 12638

PROGRESS NOTES
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MEDCOM - 5427
DOD 12639
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MEDICAL RECORD PROGRESS NOTES
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MEDCOM - 5429
DOD 12641
MEDICAL RECORD PROGRESS NOTES
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)(S)-4 PROGRESS NOTES STANDARD RIM 509 (ay. 11-71) PrescrN. CSACNR. FIRPN201-45.505 4-111
MEDCOM - 5430
DOD 12642

MEDICAL RECORD4 PROGRESS NOTES
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l PATIENTS IDENTIFICATION Woe opal or written gooier give: Name—log Pot. middle
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b)(6)-4 PROGRESS NOTES
STPNYI:DFCRM 509 pay. 11-77)

Prescribed by GSAICNR
FIN4') 201-45.505 -111
MEDCOM -5431
DOD 12643

PROGRESS NOTES
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MEDCOM -5432
DOD 12644
MEDICAL RECORD PROGRESS NOTES tlI toi\rE
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PROGRESS NOTES
STANDARD FORM 505 (Rev. 11-77)
Prescribed 4 GSA/ICIAR,
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MEDCOM - 5433
DOD 12645
PROGRESS NOTES
DATE
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* U.S GOVERNMENT PRINTING OFFICE:1985-461-775/20017
MEDCOM - 5434
DOD 12646

MEDICAL RECORD PROGRESS NOTES
DATE
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PROGRESS NOTES
STANDARD FORM 509 (Rev. 11-77) Prescribed by 60611089, FP1AR (41 CM 101-11.806-8 509-110
MEDCOM - 5435
DOD 12647

PROGRESS NOTES
DATE
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MEDCOM -5436
DOD 12648
MEDICAL RECORD PROGRESS NOTES
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-rp..,..91..,O(tP/7-,,, rO/In-.„, 4..„.-":-L22.-',-Ke,, . 0 .../":„.... A //"....,,,,,,,,,, e) c47 s ic//19/;,'sl7--,1.4-- 4;4'y(":,,)A.-,C*1
,--
(Continue on reverse side)l
. i
PATIENTS IDENTIFICATION (For weer Or InetEll entries give "...ma—lars. lint NW/ft l IREGisrEp(b)(6)-2
Polk nu* NM haphal or meth& fases")

:1))(6)-4
P
sf
Prescribed by GSA/ICMR, FIRMA (41 CFR) 201-45.505 509-111
M EDCOM - 5437

DOD 12649

MEDICAL RECORD PROGRESS NOTES
/442 iA:LE93 Air1ye'vEz : (996 cr-pvLt. OA-7,7,1 ,;,,O— f/ro,A O/02.c
-Ol''`'e4-//A 1 Ae#A eO,y4...,,,,,leye?(-e747lili4exollie.44/l6.,,e,,lee,4
7), a e nui44,..l,0)4 S S 0ll- 19-405lt5arr.'0',Z., 67-1,...4
/MeV ayki 196-11-"/47-1 evym.4.1.
/nee-4

r 4
/loboyz./P -‘.-9 -Lk../vSi-1/0 _ a3s0aosO"evevuy. 3.0 4,-„(
l P gilv.,y
cy74. 96 (A)y /AAA_y1 502 A/6 /?7,04,6__O 77)&7,4, ,5--.OI tehrs-iO6, 4-1;46O 1Ji7 ciA -1 :1O10 0
61141.-AA40 A44,t,m04
1L''))L
Lir -LkL,/r14-el e-M117214AGLI/— si)-9 7 i
(1 4.770a Dig v. 0
414-e -L/L
1--a &/- ifir az/h;yzry 2.9-.0 929 lc.-
Slit -r X.ter,40.14,, 44,e4y41/124 41 /60.7yx .y /07-yIvy__ 12-q tiv2,4yski/ ,(44.74-. ..23 \ ,,, 1
i 72- c-

an,.. 44-2 a41/44 - AleAb it-e-7 /VI comet F/ fro Aotiylinfis.f -9 2-
. 1,)00., -123
-‘,/P1-il 3y

-....A) (Continue on reverse side)
WARD NO.
PATIENTS IDENTIFICATION (Fer Wed or ulnen entries give: Name—(as lmiddle:l' - % It' REGISTER NO.
grodu".3.14. Av.; hospital or medical/malty)l,.
M (6)-4 PROGRESS NOTES
STANDARD FORM 509 (Rev. 11-77)
Prescribed by GSA/ICAIR,
FRE (41 CFR) 101-111464

509-110
M PH

MEDCOM - 5438

PERSONAL DATA PRIV ACT 1974

DOD 12650
PROGRESS NOTES
y
9-0E-4 ',./AI:eyz,,, -4
-4-O1.e4//y,i,fleg 6, s 4 ,LA ch-vi /5 1-2-:y.?-) 41/4 ' 66e .)-17}2.-6
(44c4 a-)
y3
1/43L10 PAei-l1ris72 1L-ait/141 .4L4e,pz,, 0.La­(/)2,9_57N4;4Ly)y-74,-.L.0_,..)- 2 4 A.
4Mvy,4.2A . , ;f4 iy‘ 9 se7;-? ,, yA.
, -ye/rns /Aid -y-e-4 i--6e70 Ai44-3 e,,,,, 4,1_
-V /11--r
4*,7i g-419ri4,-,--­
(0,,,z,44-ii44 0 ic ) 0 ,Zee-7 diAl
ky,--e
'-'O(' C4GGT-' 73.nO
2,2OCe-rs-.eO#I-Oeff -'O
0 4&,f — ivc, i ihy — f? bs-1--9L4s-a c-r.7/14_____ iLez.., /7/ 6e_
/11)7 A, /6/2.‘„e . a_tx.
0 .44../-L-L
b)(6) 2
? STANDARD FORM SOS BACK (Rev. 11-77)
* U.S. GOVERNMENT PRINTING OFFICE:1985-461.- 275/20017
MEDCOM - 5439
DOD 12651

PROGRESS NOTES
MEDICAL RECORD
9.-7 P63 04 ed{c_cl /1/di-rt ,?1-kr F(cir
0 35 D. awto (ck 14./vO249c,r-O61cd reek= ROyP•
Lars•-`7PEre403 5N(ieo3 1r i .244 rtNa4A4 Itue-q2¦ ((fe`le c(y3i'
ig7r2;) .
4/195 osL,h. AA/Q. go,_,,(°:_-_ 2014(cf-85
Jo--e-cc,( 4.4-eatc 2::L30 -3C Lea Sy•.6,y:--2/00- 2-e6aceedu4y
19144 eleedS = •Wng 1. --1 ,e'lAtetih6z; 621-1e5rdbj
16-4y60111y. 1C/..C.9.Se v - ...f f4...s4.. rt.L)2,,,,,,,,,n,y44,/,,,,,,,,ov.,--k%,
a 14,,, I (i-C.L/4.4/y..o c,.,/;9, pi-for-(-0 r` i).:i-e zi.resn,t,2.(41-e ,
kn i-nr-61:-1- 2,-jy. 2 14449Apee (b)(6)-2
MPH, II
LT, MSC, USNRb)(6)-2
9 cii7)153
\ ?,se R 1 - 17%, ntlL1 0 )-6,L¦0\44 te,,sL-P-R,"\f-yi) Iz's )
1
4 y(b)(6)2
.-P-P-Aev-vn wvoi-e-L Mt Lli CV *)‘‹
'e.L)141113) qTh2-L6 (vv.) 5 4)L5 ,
UW4-6-M1--1SSLLtj'tL(aL(9-y.61-6'LT Cracl-12-S i4 ''LNAS z.--yD.;-\;)/,y.)4;),:-, Al\\L
.LIA& ,Ni1L•
.15L(da-z4 191a-ocLivG-Lrillif CS 1,-- M,
2r 01° 14,5L .
ei'yNi" Lai. ,,,"^-tLrvil,y
HLlijoi-Li 5evvikvfr, g Got; -oil
9 IA 19 6, 'Jtytlit
'14)1'A LAI ),e L1-6;1 L
:P:.L '
.(b)(6)-4 fill e,Npikeon reverse side) 1 REGISTER NO. WARD NO.
PROGRESS NOTES
STANDARD FORM S09 (Rev. 11-77) Rescribel GSAMAlt.
b)(3)-1 3:
RIR (41 CFR) 101-11106-8 500-1 10
PERSONAL DATA PRIV Psi" 1974
MEDCOM - 5440
DOD 12652
PROGRESS NOTES
DATE
.L_L)
CrO2 32
14\Q V-') Ryvx L \it.K *..1,-s —L-,,L-.LV) Is-vr ,-.Nid"
C.Nd # cke: ¦;2:4-0 --- ) \ \--Z.v&v.e, & \
?_g_(,',LCor
m Y.L
I 11 k 4-016AL•

-?(L..-(61,L_....s, Ovfnl 6.‘Y.L16)Asky,
3D --..4-,N,Q ¦0,-6_.
\L../
r\nciL.-1 14tve'r‘i-e-O.L-S-6 \

Cl,
L4oj&r, ha vii-, ,e5•-fC: -)
7,-)-x, ' i-4 •-*-, 's0. iu q4-3 'Or 6 „-,,(--raLa L1±)-4-c-
o
le,bL613S (5.3L rl
STANDARD FORM 509 BACK (Rev. 11-77)
* U.S. GOVERNMENT PRINTING OFFICE u1S5-461-275/20017
MEDCOM -5441
DOD 12653

IL
MEDICAL RECORD PROGRESS NOTES
oKrg 25.-) ,---r,lol1vA-41 0 ,• (4--4-?6-a.") fit ine_AAI-A oy¦ I. ,z. .--)--...0.,L)., v13L).6,-
,,,L
)
?r-e-e.-ir •-•"'/:,,,ciLvt,eL.K.3-01-0,-c-1 Zvi 4-N4 1P/ \,--\6„fv-I.0. : 0 y)4-y.---G .-vv-yr-e--1
ataTehiyito...
A.4i' \ -i,k-i-i¦ .1li) (Yl. 5\1l— au' .•
At.'L
,b)(6)-2
.da'. .4.4-
PATIENTS IDENTIFICATION (For typed or written envier, sire: Nome--last. Pet middle.' (Continue on reverse side) I REGISTER NO.4 I WARD NO.
grade: rata; raw tempi& or medical facility)
;b)(6)-4

PROGRESS NOTES
STANDARD FORM 509 IRer. 11-77)
Prescribed by GSA/ICMR,
FIRMR (41 CFR) 20145.505

509-111
M EDCOM - 5442
DOD 12654
MEDICAL RECORD PROGRESS NOTES
-7"--€7 /et, /a j
.207-....4.0l•••••¦
fP
ce2-/1 "
'Z-
(b)(6).2 .
(Continue on reverse side)
PATIENTS IDENTIFICATION (Por typed or raises =irks give: Name—las; /bat REGISTER NO. WARD NO. vac rank rare; Imerital or mediaefealty)
I
(b)(6)-4 PROGRESS NOTES
STANDARD FORM 500 (Rev. 11-77) Prescribed by GSA/ICMR. FIRAIR (41 CM) 201-45.505 509-111 b)(6)-4
MEDCOM - 5443
DOD 12655

PROGRESS NOTES
DATE
0L0(i pn,.(\,-, \,,ciAnzw. 4010).N1
5CAO/k4-4I ' IMP S t:PO'1014:?L4 N646,(3N), Li* WTI'S/qr.)L'S"004N(jervii. 4,
G (Alory-A
J' ' riT7k.
'
V
rovy\L tC-GX-f: y6 & ljr)\ / iliLHiy13
l' )1 3 ,,53 -73
,61) , LfNJ /L6 a. L

-1(,,A_
,9
VvNAc.1,-e:h567, cieri 1,:: (-,) 1, Lr. N-3y(11.y.k,'P
— 1y9 YVIV—LJ •Ly '71,4--i- Am, k raYl.-Ld 3/3Lo-fLrof,.eL4,--c"Li v, isl,L11 h4,5,t,4 .
b)(6)-2
1-—
--:—.
LCR. MC. MR CUM o 1 INFECTOI
S DISEASE4% :';
(b)(6)-2
L
*U.5.GP0:1990•262.081/20173 STANDARD FORM 509 BACK (Rev. 11-77)
M EDCOM — 5444
DOD 12656

MEDICAL RECORD PROGRESS NOTES
DATE
?

0-*TICV?
"0-47 if I ,:trIE /0/re.cr ,r•at'PT' C'
C
„2". #"? •S-e .3/4"11 r-ss7C-r.ese
e c,
4) 4 7 $4, ,,P=r/ e) %• fs /7.-c•Ct

:?
C.9 =-4-77c,4041^ t27 -,1-4 /:7l96c,
.r.e./.7;..._ dee 09e e.
a4* 4
5.75,L
/1-1" C‘ciNht rffi -re, c) /1 + o //CI C&I5-7 e.
e) 1,10 .7 //eL/re -r/ 7.-/AC( r e 0 ?Cr-L • /­
,--e4-c247NG'
C "pc
P
/2,l Cl— c'/r -.Zee ,4" /e /
(0.1le
)

/S5 c5e,ee
QD ?c,,e;;43/0-
-1-7 -12 '
2'. O - 271 ice/

zee." f, :eNfurN—Nv./ 4-4c
er
a,-
•••
k-r
----/""t. sstsr.,t 7c3 of GIP
7
(Continue on reverse side) ?;b)(6) -2
PATIENT'S IDENTIFICATION Mor opal or mimeo ..,W _Nono—lors. fro, middle; REGISTER NO. ',auk no* .ere hospital or snakefacility)
I
(b)(6)-4
PROGRESS NOTho4
STANDARD FORM 509 (Rev. 11-77) Prescribed by OSA/IGAR, FIRMR (41 CFR) 201 -45.505 509-111
C., MEDCOM -5445
DOD 12657

PROGRESS NOTES

aquTioge3 011.eagrJyi-(4.6)1Ore-( Ru loop :0y)9(e-f'yvyd (airyd 190 it:varLAQ,.6:261cu feer1244 bse,r-vc_rj-yb,-4514_,C.5(-6-4.,y1,tx,--rei kr-r-14e14y-uvikudt, gay
Wasy''ti462.0.3 ty
r,if y
. "` , file%y91 eo ;4 Inke-- 121--. i-oup kpty,9 tve.4-0(..lerizket4
ayea_ 4)14,6()k_&c_s5e.r., e • Lett, r?_se-s Meal1 ecr-er gez,i-s ri/_e-,yP leet6e- oe..62)121 if° tip-4IeO'ea KAJtsr,s Ptz Z--QM WNL z el t-a -r -41( 04z741:7-ese.,
(b)(6)-2L
rPli, RD LT, MSC, USNR M(6)-2
(10)(6)— 2
L
*U.S.GP0:1990-282-081)20173 STANDARD FORM 500 BACK (Rev. 11-77)

MEDCOM - 5446
DOD 12658

4
MEDICAL RECORD PROGRESS NOTES
DATE
/4/1/F#7 6 3 %ea /(ed7c-`c
0 '420
-
1..-c,riCa-ty - c.,,y7••1=)y/5/1//`/Ft)y/1/-0y,fy7 '`.-yei_Liq,./p,),, ..,
7-.?...i,4c so ,v
,..0.-wc-o /5 7 / 1-y/1. cN1A-b-P.cilL44-e (:.-
IWei. ;If t.t.u.x1 ,r,z.? k,L6 4, G c - 7 4-
ef,A 4f‹ v-2 Top ,y
6-4 / 1 4 rte(y.
6,j ct, ,t t L. t.f. /s,L.Pc.1/5 CyAy//e,L
/7 V
fipei,.4.514 L(.i itt 4 /4 '.'r?A' `c= /?d, S? // ° a.
P.X9.74 s?p . 2 4. .

/ Y l'.•L-L.? ...-Z1
,..ktr.
ti ,4-. '..-1-(-`44. --L(.)L.z, of-,_L1?LV 411 ea y C LtLte;"y.,,,,,L',..;,,4. ./.‘,1„,.
7 r',79 Cn-f..........,........ ry7ey.:./..; 4C4/—
1
AA,' 4:e
l-
C
rcy —y. //44 et.,... I
t3. )
S).y-ei:L..-4,-y6--...4,,.y7,.."-p r, ey_yeC.
...,
yrs, cr /L/..---e /L/C "—L•
"b)(6)-2
(b)(6)-2 .,b)(6)-2
(COnrinue on reversel" PATENT'S IDENTIFICATION (For tyrd or IVMFAIN sorrier pre Nomo—Isur, PA 4.iskilr REGISTER r41 I WARD NO. Srmk Auk nay Mom/ or magical Adds))
PROGRESS NOTES
STANDARD FORM 509 (Roc 11-77)
Prmierloe0 by GSA/IDIR,
FIRMS (41 CFS) 201-45.505

509-111
MEDCOM - 5447
DOD 12659

PROGRESS NOTES
5/ iylAxa\ -eNtnywrefec-k'1,-dv\ 1, -1L454 451LlieinN56s-Pckr.
iy J
q- ea CI,L\-rL-1\ 7s cfiN),Q D -
li -OCD
,Ex-,-' -; c--A
r---7"' 1 710)4\r,rd \ e't 'il4T -...54(--J
9- - -- '1)4Ce -1s /1 -4e laL) i¦ i& --(Dro I, jcL9'6
.---P.,61 t41-a\ ‘(-.'4‘ VA4-4 7-?3ln411N5N7 -711v11-0
INFECTIOUS!)
,,Aw,ro-vAK al \451" -Q\4ck --) 1 1M f -4' 8,1VA 1 4- -,
ALI
-2,-R-e/7, 7NoarkNor Nl'ollil
a weeLyew\ adL. ____.
.L.
71.

• (6)-2
*U.S.GP0:1990.282.081120173 L STANDARD FORM 509 BACK (Rev. 11-77)
MEDCOM - 5448
DOD 12660
MEDICAL RECORD PROGRESS NOTES
DATE
6
44-v
' 1^eik1A,, so ¦ 6\ .Lv,A.,4111AL:ILI
.s 7--L) i\B
),i, J\J ANS

1-,12n1Q1" i Oi ''2_l ,4,,t,,,NlirLVit lic%
._,..„L,_.4
'':::) kl-eAlt WI Cne)ee\ -k I -e, \,.,..:P A\ jrj,Nvex ..) ciL(1,60 +4L5 iL. 'CP-
- Li 4 ,A 0 --1 e--a ,.:: ILL-A.p,eivn i ciLcis,A -(01Las)a-6 I-
b)(6)-2
b)(6)-2
4.10C; USflitaka.m:l*,.
TRA D2LSFASF . -,
. 611441 03 4? Z9i7-4"( F7 0 r
fill -04C-44) ji}t .-yry
1115-5 fee-ii(--cuAsy-yi-, S'izcie-5. het-S not4 CD/A4
V Os-4
V O
Ne4-4cN1)(c y
, 3 -0. /y
LNI es2, (. 5 ¦ 4E
0 1' ii_5a-i:.,-. Per0.:1e,(14146P, ' . 1 -/', a .‘cLIL ( Ld
, 4 r. i.L.ii
1L.ins 24/1144cy24-6 /-la/ 'LII(3(L`• ( ,i, 1s,,D0
060 (206
6-1,-)c...z64, 511 103 c420;*-;t4 5_4 ,___,,,,.--x,s-___,4=-ipt_r
.-II y1 u ma_ , 697,(.40cOvz..4y.eneriti. 6.6
gloci,fyU 0 ,,,ze. teve.A PO i kibize& . gz-e_s304(44.4A0(10e_owut.LPo 1,04./1"-e;v) 'wail, vicYkg 6::;v-- RC 4 asqaalie oriirst i sist kb ) b u/ 5 i e7 i-644,44%
!"61vtyb(yt-1--y
PATIENTS IDENTIFICATION (For typed or written amain Oa Name—leaL Jim middle: REGISTER NO.,1244. 64 jej grade: rank rare &viral ormedical facility)
b)(6)-4
PROGRESS NOTES
STANDARD FORM 509 (Nov. 11-771
.....— ...? .,...... I (41 R) 101-11.406-8 508-110
MEDCOM - 5449
DOD 12661

PROGRESS NOTES
His' ccvit_e_, 2e7 )4-Pi,e.,03, r- F pi re-i-z*,--s *Od nLear-odj, 4­1/ace 1,p.e& I ) OC,(-cr el5..,,zLko iiv 4,,,a,t(fa,„ P05,4417,k4-4_ Ao-r-ild-LA,) AP.4-6 4-- .94-g fai--e,rv(600, a.,,ID ,o,,, 2,-3cLuis, x4,1) b)(6)-2 L MPH, RD LT, MSC, USNR `b)(6)-2
2?A/05 IA4:4 RP/. 34.. 4, /1 4(-4. ' '4..* ii ley,:cd b)(6) 2
, ii 4, ;IA.L1 i..5 /6- 3-5
''''t-• ?)Gtfri,k LAil,y —4 i4Lvi c„.
1y•-z. ottt,t,y., c,,,4yAI4411,,,,1y(b)(6)-2 , ee"-‘..r--LA

L STANDARD FORM 509 BACK (Rev. 11-77)
4. U.S. GOVERNMENT PRINTING OFFICE: 1955-451-275/20017
MEDCOM - 5450
DOD 12662

?
MEDICAL RECORD PROGRESS NOTES
DATE
t 1-Sew 41 P.L
.L-ko R.4ravL04. 0 LE, Ed--L
c-{0 t a (sn
V's-Le7e4e.), s-; On . A iZ -iL
OD '— I 26 ?(b "F.,
thf °L&L
b)(6)-2
T'-1 , T-e41--,
o46 AgLDvL9\,-s crec 6,4s ) eri-A I \ y
Pk le

30,1

_e
.
Ivy-v)o-,c --) (7---41BL55.1LAIVLTVP GS
Q
14-WW-1/6 (-1-4:/\ ....' eN) ra*Y1n NI. i LiL
---ckL, 0k 4.v, (C2)L01( -1'-'11 191-3 akteet,L0)7P-1111
C76--,14 1;1 k-i.j'L1-•%11 l'eAIN.e....1,"4. .anill , k 111,) /\NWien. eye b)(6)-2
L
(b)(6)-2
-":4C1)8,i6tif5NR-01161.1._-
INFECTIOWTFARE.4, •
1?31k1 ck' 63 ‘'':i ,4. 41 --?
TA?• , I?-?i?aa-e) \)0AL• .
-•1`?
/? '?4 tv¦oD\.4-?c eizsiurtS kkty..),,..l?4:)B?-6?5-61c?vaAV-e-t..?etv-ILL4-4 (2,
j_
h, t pai ,) 0 Lc. ? -k-Lnon-(P" ^( lny
r"L-("6";kL?' 'L..6 44s ''':L(b)(6)-2
'46'1'2-N
c4;6A,:k1
(
4.. pre ¦JeA A.0 brit ck COL4,-.2, v.A.. oucktc,D.L. --- ki", cemF)
(Continue on reverse side) _ ? .7._T 12. C.L.,
PATIENTS IDENTIFICATION (Few typed or written entries glow: Name—lash Jird. middle:l 1 REGISTER NO. WARD NO. rode; wink sow hospital or medical facility)
b)(6)-4
PROGRESS NOTES
STANDARD FORM 509 OleT. 11-77) Prescrih.NGSA/1CMR,
FIRM'?201-45.505
111
MEDCOM - 5451
DOD 12663

.-
G-NO
4.1, . _A...y.1.,...y• -y14y- .../.. rir."y, .....6( . ,..Z..
„A//4 I p
__ .11 dr,yA / ...0 , 61L.4417 4L.
...1)L-'4'L
e .e,
•••_,
.%. - / ..1( •,2c..)_. 1/ 1_/21?Ai -4l.4.
.,O R
'yO._,O,e...._O_ / ,e_.., O4,.O.1.0-4
e61-1,4,,,y-2,4, //6,1-___ey2)z,0_,,, __€_.-t., „e,”
(b)(6)-2
(-/ VI/A* frr P. rE `4-5V,-, L
7 4-,/L€4," (b)(6)-2
Av-i-u-, IyAR—)
e", C ati.,,, I •4) 71 a .y10 -y0 z.4 -yp219'4yAA, 69- r
git-i1 c.i, .9y,LArre -Lft"..i., -L4-r--72.e,r2oz,Or--?A-?flii) ../41.?s_f-yei,
b)(6) 2

72Ldef„“ -rty0--A.,,, /Avf 07...teeer7y/I.e.?, ­
4e
?
* U.S. cows/Row PRINTING OFFICE = 1985 0 - 461-275 (20166) STANDARD FORM 500 SACK (Rev. 11-77)
MEDCOM - 5452
DOD 12664

NURSING NOTES
(Sign all notes)
OBSERVATIONS
DATE

HOUR
Include medication and treatment when indicated
P.M.
C61-4 PLC, Pr/ C._ Vtp.A., A.) 8 1-2 —1')(6)-2
2-R03 /82,f) AcAry-1;-4--L
Roo ile5s,ara_ot c.l-€t-crF e r. 7T 0,0
b)(6)2 ---1(b)(8)-2
1905 2s)L?,rtyrrtaLAm P4, AN). p‘,sk..4RNti I2131 S-
Assi's5A4 001-ccoNAFLeTE-D.4euizz. 7 FT- OS 111/N SWF TD i Iry sr.AAA,4tEgLA
63-rik c/k-s r-uwes Cc, F•icrArP-14-n4Sf0 A31-71.0erst-41.3 C ber$20,L•ncs v350. 1
ertal
toNo24. cgRp^o: 51S )5T-- r B.P.4 121D .4
+ fut5es )%4t 9/0431 gfg fir, 4.4,LAsrAcc)
Sc..1-5 i/00 v. hiC PA.OD rlegad?lv;-0 z 0-(r so:/. L01-14, . PrEcb 54-4-X10 "ThkrcASi nm-Ir4gotsiroG e1/4.).:•re t.
01.01-c4s-PA eiv-r cti-ecic.e-to Ikbok..e-0)
Stsc—rt.o.,-)4 -1-o-r3ElA-) 0 ST7L-1 L. Q) 7. F. QNTio-4.4' •4 tEy
L
'2. I PO Ail., air4 k-'/451e-4 To
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NURSING NOTES Standard Form 810
MEDCOM -5453
(Reverse)
DOD 12665
NURSING NOTES
CLINICAL ROD (Sign all notes)
4
HOUR OBSERVATIONS DATE 44
A.M.4P.M Include medkotion and treatment when indicated
I I .
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PATIENT'S IDENTIFICA ION4
(For typed or written entries give: Name—last, Pit, 1 REGISTER NO. WARD N 0. middle; grade; date; botpital or medical facility)
?U.S1988 0-401 -245 (40045) NURSING NOTES
*. GOVERNMENT PRINTING OFFICE .
Standard Form 510 PRESCRIBER BY CSA/ICMR FIRMR (41 CFR) 201-45-505 510-110
104-ESS1 AY G4et. TO4a
...
wiraL7.:Lvobtem9.44.
MEDCOM - 5454
DOD 12666

NURSIN6 NOTES
(Sign all notes)
HOUR OBSERVATIONS
DATE

A.M. P.M.. Include modication and treatment when indicated
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1:0(6)-4
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MEDCOM -5455
_ __ • •
DOD 12667
NURSING NOTES
CLINICAL RECORD (Sten all notes)
HOUR OBSERVATIONS
DATE

Include medication and treatment when indicated
A.M.4I.M.
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PATIENT'S IDENTIFICATION4
(For typed or written REGISTER NO. 1 ...Am, mai.
extra gine: Name—last, first,
middle; grade; date; hospital or medical facility)

NURSING NOTES
Standard Fenn 510
"p)(6)-4
'Prescribed by CSR/ICIARFIRMR (41 CFR) 201-45.505ocroatft 1975
510.110
MEDCOM - 5456
DOD 12668

DATE HOUR A.M. P.M.. NURSING NOTES (Sign all notes) OBSERVATIONS Include medication and treatment when indicated
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NURSING NOTES Standard Form av
MEDCOM 5457
-tRovarmal
DOD 12669

?
CLINICAL RECORD NURSIN:ll NOTES
4
HOUR OBSERVATIONS
IJAIE
Include medication and anahnent when indicated
A.M. P.M.
`i AO 10'5
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YAittNi IDENTIFICATION •tree Typed or written entries give: Name—fart, REGISTER NO. WARD NO.
middle: grade; dale; hospital or medical facility)
1 C_U )0(
GOVERNMENTPRINTING OFFICE : 1986 0-491 -248 (40045) NURSING NOTES
Standard Fawn 510
(b)(6)-4 FNECFEER BY 95/1/1CMR FIRMR (41 CFR) 201-45-505 510-110

MEDCOM -5458
DOD 12670

(Sign all notes)
HOUR OBSERVATIONS
DATE
M. India* madkation and heannent when indicated
..M..
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MONO NOTES
mammas nein no MEDCOM - 5459 (Rome
DOD 12671

NURSING NOTES
CLINICAL RECORD ( Sign all notes )
HOUR OBSERVATIONS
DATE

Include medication and tivalmant when inditaNd
A.M.4P.M.
VZIO2 er-ftt.. T V 2LC:',-) ca )R0,141\110004--TI A",NOn. i.. .L').nNFnIZ MEDSNr.1.-uir,5 '.¦L1.10
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PATIENT'S IDENTIFICATION?)(6)-2 ---"--
( 'or yped ar wine! entries give: Name—last, first, REGISTER NO.4•WARD NO. middle; grade; date; hospital or medical facility)
1(b)(6)-4
NURSING NOTES
I 1 Standen' F01717 510
PresalbedlyGSA/ICUR
BRIAR 141 CFR) 201-45.505
OCTOBER 1975

510.110
MEDCOM - 5460

DOD 12672

NURSING NOTES
CLINICAL RCM ( Sign all moles)
4
HOUR OBSERVATIONS
IJAIC
Include medication and treatment %when Militated
A.M. P.M.
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PATIENT'S IDENTIFICATION4
(For typed or written entries give: Name—last, first, REGISTER NO. WARD NO. middle; grade; date; hospital or medical facility)
:b)(6)-4
NURSING NOTES Standaird Form 510
_frpq!kociLGA/Ichul _
OCTOBER OM 510-110
MEDCOM - 5461
DOD 12673
NURSING NOTES
(Sign all notes)
HOUR OBSERVATIONS
DATE

A.M. P.M. Include medication and treatment when indicated
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MEDCOM - 5462
DOD 12674

NURSING NOTES
(Sign all notes)
OBSERVATIONS
DATE

HOUR
Include medication and treatment when indicated
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Standard Form 610 (Reverse)
MEDCOM - 5463
DOD 12675

CLINICAL RECORD NURSING NOTES (Sign all notes)
IlHOUR OBSERVATIONS
DATE A.M. P.M Include medication and treatment when indicated
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PATIENT'S IDENTIFICATION4
(For typed or written entries give: Name—last, first, REGISTER NO. WARD NO. middle; grade; date; hospital or medical facility)
NURSING NOTES
Standard Form 510
General Services Administration and
Interagency Committee on Medical Records
FPMR 101-11.806-B—October 1975

MEDCOM - 5464
DOD 12676

SING NOTES
( Sign all notes)
OBSERVATIONS
DATE

HOUR
Include medication and treotment when indicated
A.M. P.M.
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Standard Form 610
(Reverse)
M EDCOM - 5465
DOD 12677
CLINICAL RKORD NUTYpiPt NOTES
HOUR OBSERVATIONS
DATE
Include medication end treatment when indicated
A.M.4P.M.
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PATIENT'S IDENTIFICATION4
(For typed or written entries give: Name—last, first, REGISTER NO. WARD NO. middle; grade; dare; hospital or medical facility)
NURSING NOTES
Standard Farm 510
General Services Administration and
Interagency Committee on Medical Ripcords
FPMR 101-11.806-8--Oetobar 1975
510-109

M EDCOM - 5466
DOD 12678

HOUR
DATE
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011SERVATIONS Include medication and treatment when indicated
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DOD 12679

CLINICAL RCM Numua NES

HOUR OBSERVATIONS
DATE

Include medication and Heannent when indicated
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PATIENT'S IDENTIFICATION4
(For typed or written entries give: Name—last, first, REGISTER NO. WARD NO. middle: ere; dale; boepital or medical facility)
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11111DRISIO MIMSC
Standard Fenn 510
Prescribed by CSA/ICIARFIR (41 CFR) 201-45.505 nrIARFR 510110
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M EDCOM - 5468
DOD 12680

HOUR DATE 1-4
A.M. P.M..
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NURSING NOTES
( Sign all notes)
OBSERVATIONS
Include medication and treatment when indicated
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NURSING NOTES Standard Form 510
MEDCOM - 5469
(Reverse)
DOD 12681
NURSING NOTES
CUNICAL RECORD
(Sign all notes )
HOUR OBSERVATIONS
DATE

Include medication and treatment when indicatedA.M.4P.M.
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or tyPea REGISTER NO. middle; grade; date; hospital or medical facility) (For or written entries give: Name—last, first, WARD NO.
*U.S. GOVERNMENT PRIMING OFFICE : 1986 0-491-248(40045)
NURSING NOTES Standard Form 510
is .i 4BY GSA/ICMR
FIRMR (41 CFR) 201-45-505
510-110
4^^:,.
MEDCOM - 5470
DOD 12682

NURSING NOTES
CLJNICAL RKORD ( Sign all notes) _(
HOUR OBSERVATIONS
DATE

Include medication and treats ant when indicated
A.M.?P.M.
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(For typed or toriiten extriet give: Name—hut, Bret, REGISTER NO. WARD NO / dl _ rads•dale•bot ital or medical facility)
7_J)
NURSIG NOTES
Standard Form 510
Prescribed CSATICMR
BM (41 CFR) 201-45.505
OCTOBER 1975
510-11D

MEDCOM - 5471
DOD 12683

NURSING NOTES
(Sign all notes)
011SERVADONSHOUR4
DATE?
kale& medication and treatment when indicated
A.M. P.M..4
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MEDCOM - 5472
DOD 12684

NURSING NOTES
CLINICAL RECORD (Sign all notes)
OBSERVATIONS
HOUR
DATE Include medication and treatment when indicated

A.M P.M
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PATIENT'S IDENTIFICATION WARD NO.
REGISTER NO.
(For typed or written mines due: Name—last, Pit,
middle; grade; date; hospital or medical facility)
:i3)(6)-4 NURSING NOTES
Standard Form 510
General Services Administration and Interagency Committee on Medical Records FPMR 101-11.806-8--October 1975 510-109
MEDCOM - 5473
DOD 12685
NURSING NOTES
(Sign all notes)
OBSERVATIONS
BATE

HOUR
Include medication and treatment when indicated
A.M.4P.M..
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MEDCOM - 5474 Mamma
DOD 12686

NURSING NOTES
CLINICAL RECORD ( Sign all notes)
OBSERVATIONS DATE
HOUR Include medication and ointment when indicated
A.M. ..M.
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PATIENT'S IDENTIFICATION . (Far typed ac( written e .14, give: Is( „aja.....1a, fir,, , .l. REGISTER WARD NO.4•
I . .STER -.!..4°4-• :
;....7:1:-...1.t;;-,Inidelir;gy'n;lie;'date; inspitnI Or . ;neolicai facil;;:y) __"-._
NURSING NOTES
Standard Form 510
Prescribed by GSA/ICMR
FIRMR (41 CFR) 201-45.505
OCTOBER 1975
510-110

MEDCOM -5475

DOD 12687

NURSING NOTES
(Sign all notes)
HOUR OBSERVATIONS
DATE

P.M.. Include medication and treatment when indicated
A.M.
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It U.S. GOVERNMENT PRINTING OFFICE = 1983 0 - 421-5 2 6 ' 10 1 ) LNURSING NOTES Standard Form 610
(Reverse)
MEDCOM - 5476
DOD 12688

y
NURSING NOTES
CLINICAL RECORD (Sign all notes)
OBSERVATIONS
HOUR
DATE Include medication and treatment when indicated

A.M. P.M. 11yf
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PATIENT'S IDENTIFICATION?(For typed or written entries give: Nle—last, first, REGISTER qa.
middle; grade; date; hospital or medical facility)

(b)(6)-4
NURSING NOTES Standard Form 510 General Services Administration and Internency Committee on Medical Records
FPMR 101-11.806-8--October 1975 510-109
MEDCOM - 5477
DOD 12689

NURSING NOTES
CLINICAL RECORD (Sign all notes)
OBSERVATIONS
HOUR
DATE Include medication and treatment when indicated

A.M. P.M.
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WARD NO.
PATIENT'S IDENTIFICATION?(For typed Or written entries give: Name—lass, first, REGISTER NO.
middle; grade; date; hospital or medical facility)

NURSING NOTES Standard Form 510
General Services Administration and
Interagency Committee on Medical Records
FPMR 101-11.806-8—October 1975

510-109
M EDCOM -5478
DOD 12690

NURSING NOTES
CLINICAL RECORD (Sign all notes )
HOUR OBSERVATIONS
DATE

Include medicotian and treatment when indicated
A.M. P.M.
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Continue on reverse side
A i I t?'IDENTIFICATION

(For typed or written entries give; Name—last, first, REGISTER N 0 WARD N 0 '''?J..' dais; hospital or medical facility)
:b)(6)-4
NURSING NOTES
General Services Administration and Interagency Committee on Medical Records FPMR 101-11.806-8—October 1975 510-109
MEDCOM - 5479
DOD 12691

Doc_nid: 
3555
Doc_type_num: 
72