Medical record relating to a 42 year-old male detainee referred by CID for physical and history. When examined, no recent injuries were found.
0 9 11 so6th`5915A2 AUTHORIZED FOR LOCAL REPRODUCTION MEDICAL RECORD CHRONOLOGICAL RECORD OF MEDICAL CARE DATE SYMPTOMS, DIAGNOSIS, TREATMENT, TREATING ORGANIZATION (Sign each entry) (24. L) I C ")_. -J iL feeereci fi) cc, ,cr," M . I 9 74. bL- /A, e4A, //e, derv , c _ e_ad J ." t, • :.C.4- 4. R_-c:j 4,,,ceo) z=fr .____ 66•36-_-: A, (._ __ __ _ _ _ /L:-.,- (..)/u. ) _ illt9vr —JCL__ _ ..ez: -4E6_ i Jr-' c.'44.i L--'1 Fii -002,-/c1 Z26,-,-/ IcAl:j• -CI-4'r tfri-i24--—R_AT. ._Z_121t.v=','IL-4-.S x ,ifr&P - nic71/4-tr3i'L.; / C.-4 el-01S. c:4:- ..-i 4 -'57 jel — _ ii: *. I ' iii.Z-q__L:1, . ' x -11W Ct / Itt.--C CV ECC71C, At, c.kir-3 r /do ) re; 1 2 CY/lea-1 3c. it'7 z.) k_7-1 1.-r._ 2. c'gs4.... gA,..d. 6„ hip,,j4(b)(6)-2 HOSPITAL OR MEDICAL FACILITY STATUS DEPART./SERVICE SPONSOR'S NAME SSN/ID NO RELATIONSHIP TO SPONSOR PATIENT'S IDENTIFICATION: (For typed or wrinen entries, give: Name - first, middle; ID No or 5SN; Sex,. Date of Birth; Rank/Grade) REGISTER NO. WARD NO. NAME: RANK: CHRONOLOGICAL RECORD OF MEDICAL CARE Medical Record SS N: DOB: STANDARD FORM 600 (REV. 6-97)Prescribed by GSA/ICMR V (2_ FIRMA (41 CFR) 20 1-9.202-1 UNIT. USAPA V2.00 MEDCOM - 609 rn-c• IlVT7Trq A I2..Car_cw-r - fi DOD 003672 0138-04-C1D259-80202 AUTHORIZE.° FOR LOCAL REPRODUCTION MEDICAL RECORD CHRONOLOGICAL RECORD OF MEDICAL CARE DATE SYMPTOMS, DIAGNOSIS, TREATMENT, TREATING ORGANIZATION (Sign each entry) REPORT OF DETAINEE MEDICAL SCREENING: listory of Past. Medical Conditions: (circle) High Blood Pressure. Diabetes, Heart Failure, -kid Faure,ure, Seizure;;. StrOke, Blee,ding ' _ Chronic Bowel prohlems:ftyroid . Medication Allergies: (NO) (YES) List - Current. Medications: (Name/Dose/Frequency/Last Taken) (NONE) ' A Recent Injuries: (1\19,y (YES) Describe Exam Finding: BP: ) • / 0 Pulse: (.76/-Diagram and Space Below to Indicate Examination Findings. continue on reverse (Flii) (UNFIT For Confinement _Does oes Not equire Further Eval Name/Rani:A nit of Screener DEPART /SERVICE RECORDS MAINTAINED AT STATUS OSPITAL OR MEDICAL FACILITY RELATIONSHIP TO SPONSOR SSNiin NO. PoNSOR'S NAME REGISTER NO. WARD NO. ATiENT'S IDENTIFICATION. (For typed or written entries. give: Name - last, first. middle; ID No or SSN; Sex; Date of Birth: Rank/Grade.) Detainee Information: I *I HRONOLOGICAL RECORD OF MEDICAL CARE :b)(6)-4 Name: Medical Record i STANDARD FORM 600 (REV. 6-97) (b)(6)-4 Prescribed by GSA/ICMR - '- USAPA V2 DO Control l umber: FIRMR (41 CFR) 201-9.202-1 0 MEDCOM - 610 Date/Time of Detention: -'-'1.77M-'-ec7747e17 Ir 3fr DOD 003673