Medical Report: 50-Year-Old Iraqi Male, Detainee, Baghdad, Iraq re: Gunshot Wound to Abdomen

Medical report of a 50 year-old Iraqi male detainee with gunshot wounds to the abdomen and torso.

Doc_type: 
Medical
Doc_date: 
Wednesday, May 7, 2003
Doc_rel_date: 
Wednesday, June 15, 2005
Doc_text: 

I 1. REPORTING MTF .1"F LOCATION I •
ADMISSION AND CODING INFORMATION
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Country
b)(3)-1 For use ol this form, see AR 40400; proponent agency Is OTSG
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3. REGISTER NUMBER b)(6)-4 Wddle Initial). 14. PAY GRADE 15. SEX
9 10 111 12 113 14 15 16 17 18 b)(6)-4
6. DATE OF BIRTH (lYYYMMOD) 1 7..AGE AT ADMISSION 1 8. RACE 19. ETHNIC I RELIGION 19 20 21 22 23 24 25 26 27 28 29 -. . 30
—3-1— BASWND I
I 10 LENGTH OF SERVICE ETS i 11. FMP 12. SOCIAL SECURITY NUMBER I.I 1
32 33 34 I 3 36 37 38 39 40 141 1 I 43 44 45
(b)(6)-4
ORGANIZATION (Active Duty Only) 13. MARITAL STATUS HOUR OF I BRANCH / CORPS ADMISSION 46 giO 15 I
14. FLYING STATUS • 15. BENEFICIARY CATEGORY 16. ZIP CODE OF RESIDENCE
47 48 49 SO 51 52 53 54 55 56 57 58 59 60 61
17. UNIT LOCATION (State or Country Code) 13. MOS 19. TRAUMA PREY ADMISSION
62 63 64 65 66 67 68 69 70 71 YEAR .
20. SOURCE OF ADMISSION/ AUTHORITY FOR • WARD k. N) NAMURELATIONtil call EMERGENCYADoRessee NO
ADmIS ON
72 1 -Ike (t oo 1 ADDRESS OF EMERGENCY ADDRESSEE MIciude 21P Coin)

TELEPHONE NUMBER OF EMERGENCYAODHESSEE
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21. TYPE OF DISPOSITION 122. MTF TRANSFERREDT J 23. DATE OF DISPOSITION r M two I 73 74 75 76 77 78 79 80 81 82 83 85 86
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24. CLINIC SVC -ADMITTING 1 25. MTF TRANSFERRED FROM 26. DATE THIS ADMISSION (YYMMD D) 87 88 89 90 91 92 93 94 95 96 97 8 [ 99 I 001 1 101
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27. LOCAT ON OF OCCURRENCE 28. MTF OF INITIAL ADMISSION 29. DATE INITIAL ADMISSION (Y Y V M 0 0) (BailieCasualty Only)
103 104 105 106 107 108 109 110 I 111 112 113 114 115 116
FOR LOCAL USE
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MEDCOM - 5831

DOD 13043

ADMISSION AND'CODING INFORMATION
Fot use of this tom, see AR 40-400; the proponent agency is the OTSG
30. AGE Al DISP 31. AUTOPSY 32 UNDERLYING CAUSE 33. RESIDUAL DISABILITY 34. DO NOT USE . DATA FILLER #1 35. CAUSE OF INJURY
3C99 -11100031A1

117 118 119 120 Y / N 121 OF DEATH! SEP 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136
36. FIRST DIAGNOSIS (Principal Diagnosis) 137 138 139 140 141 142 143 q q , 39. FOURTH DIAGNOSIS 144 37. 145 40. SECOND DIAGNOSIS 146 147 148 g Z.1) FIFTH DIAGNOSIS 149 150 ..., . ;..::: ,....„.........,,, 151 152 38. 153 in THIRD DIAGNOSIS 154 155 156 SIXTH DIAGNOSIS 157 158 159 160
161 162 163 164 165 4 2.SEVENTH DIAGNOSIS 166 rir1..-*4:. 167 168 169 43. 170 171 172 EIGHTH DIAGNOSIS 173 174 175 176 177 178 179 180 181 182 1 183 184
185 186 187 188 189 190 191 192 193 194 195 196 197 198 RI 199 200
44. FIRST PROCEDURE (Principal Diagnosis) 201 202 203 204 205 206 207 e. fir 17. FOURTH PROCEDURE 208 146. 209 48. SECOND PROCEDURE 210 211 212 213 .,....::. FIFTH PROCEDURE 214 215 216 1 46. 217 49. THIRD PROCEDURE 218 219 220 SIXTH PROCEDURE 221 ...R.,:: 222 223 224
225 226 227 228 229 230 231 232 233 234 235 236 237 ..:.:. 238 239• 240 241 242 243 . 244 245 246 247 248
50, SEVENTH PROCEDURE 249 250 251 252 253 x.-:. 254 255 256 51. 257 E IGHTH PROCEDURE 25B 259 260 261 262 263 264

1717 0£ I, 000

52. NUMBER OF DIAGNOSTIC FIELDS 53. NUMBER OF PROCEDURAL FIELDS 54. PRIMARY PROVIDER 55. BLOOD USAGE
CONTAINING CODES CONTAINING CODES , I SPECIALTY CODE Y/N 265 266 268 269 270 1 271 I 272
03
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—I ADMISSION AND CODING INFORMATION
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li(;)(4.1r flume mitrag 1 5. SEX
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6. DATE OF BIRTH (Y Y V Y M M D DJ 7. AGE AT ADMISSION I 8. RACE 9. ETHNIC I RELIGION
19 I 20 I 21 22 123 24 I I 26 27 26 29 1
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LENGTH OF SERVICE ETS n 11. MP • I 12 SOCIAL SECURITY NUMBER
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ORGANIZATION (Active Duty Only) i 137 MARITAL STATUS I Drumm. 1.;LINrs
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ADMISSION
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14, FLYING STATUS . 15. BENEFICIARY CATEGORY 1 16_ ZIP CODE OF RESIDENCE

49 52 53 55
47 48 fl 51 54 56 57 58 59 60 61
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17 UNIT LOCATION (State or 118 MOS 1 19. TRAUMA PREY ADMISSION
Country Code)

YEAR I I NO
62 63 164 1 65 I 66 I 67 I 8 I 69 1 70 71
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1 7--. I I I 1 I I L..-11 '1/4i 1 2(4OURCE CF ADMISSION/ AUTHORITY FOR I WARD NAMEELATIONSHI CF
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ADMISSION
ADDRESS OFMERGENCY ADDRESSEE (Include ZIP Coda?
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b
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21. TYPE OF DISPOSITION 22. MTF TRANSFERREDTa
123. . DATE OF DISPOSITION (YYMMDD)
173 74 n I 75 1 76 77 1 78 1 79 I 81 82 83 84 85 86
I CP rkt 1 n ,, 11 0 "11
I 24. CLINIC SVC - ADMITTING 25. MTF TRANSFERRED FROM 26. DATE THIS ADMISSION (Y Y M M D D)
I 1
187 88 89 90 1 91 192 93 94 95 96 I 97 98 99 100 101 1
liAle) le n 1 I 1 1 vv.
1 27 LOCAT ON OF OCCURRENCE 28. MTF OF INITIAL ADMISSION 29. DATE INITIAL ADMISSIOW(Y Y.M M D 0)
• (Battle Casualty Only)
104 105 I 1109 113

103 1 0 6 I 107 108 110 111 112 114 115 116
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FOR LOCAL USE
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M EDCOM - 5833
DOD 13045

Doc_nid: 
3568
Doc_type_num: 
72