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

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ADMISSION AND CODING INFORMATION
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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
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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)
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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
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123. . DATE OF DISPOSITION (YYMMDD)
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I 24. CLINIC SVC - ADMITTING 25. MTF TRANSFERRED FROM 26. DATE THIS ADMISSION (Y Y M M D D)
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1 27 LOCAT ON OF OCCURRENCE 28. MTF OF INITIAL ADMISSION 29. DATE INITIAL ADMISSIOW(Y Y.M M D 0)
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M EDCOM - 5833
DOD 13045