Medical Report: Iraqi Male Detainee, Baghdad, Iraq re: Gunshot Wound

NEN•7540-00-634-4t59
EiLOOD-Okfltpop, COMPONENT TRANSFUSION .
SECTION I ,,'REOUISITION
TYPE OF REQUESt . (dhecr5 ONLY ff./0d BIOV0 Cell ..•
014qk one)
Products are requested.) -.•
eTYPE AND . SCREEN.
E2'OEN PLASMA
"CROSSMATCH
.5afipoiv .
iRgorgWATE (Pool.of .units) DATE REpiSj.E.,E.),(43 have the
I c011ected. -a: blood specimen on below named Patient,. verified the name and ID No. of the . patient a nd ; We ,s±ibienen tube label to be
DATE AND HOUrg,* ,
tOrreCt.. '.
OTHER (§peOiti,) . kbke}2
ATIONRANSFIJSION
KNOWN ANTIBODY F f/T
v(iLDNAE•4p • 4 :FED.(l7f volicable)(..., ..,
REACTION (Specify)
. . .:(7`3: ,
j
;174E'RE HISTORY OF: DATE VERIFIED
IF PATIENT IS FEMALE S
REMARKS:
Xea M/I1/4Y)
RhIG TREATMENT? D VEN: :-TIME VERIFIED. HEMOLYTIC DISEASE
2
SECTION II – PRE-TRANSFUSION TESTING
bxe)-2
PREVIOUS RECORD CHECK:
TEST INTERRRWMICifir: :-. ,.
DNITNO:4.142:‘4 .
ANTIBODY SCREEN CROSSMATCH El RECORD.I 1 NO RECO
b)(e)-2 .
PATIENT:No. :
CSD f.b P =ST
r
e)k9:2-' t.,y, 03
DONOR ED pao
cRossiviAtdkNOT REQUIRED FOR THE COMPONEIVI–Kewes-rcv

13 REMARKS:
A
44,
Rh
427Era ie–PCX*'
SECTION III; RECORD . OF TRANSFUSION
Po
POST-TRANSFUSION DATA
PRETRANSFUSION DATA TIME/DATE COMPLETED/INTERRUPTED
11C1.1 ov
J,56')-7-
Z7.H6:14 n3 oejA 0
REACTION ;TEMPERATURE, " PULSE.BLOOD PRESSURE
NONE, f=1;*IPCifEri.: 91.) 111-to
AT
.411Mmilimisii II• 9
....:''.
IDENT! . ATIO l•.
..: • :.
....
.....
piiponirriud:tirisfe4106,::tekricr.5gLiff:tir:oent,' , Keep intravenous lihe opeh.
I have examined . the Blood'. Component container 0061 ,:ancf this term arid F iiii ,c:011-.,
information identifying the container:Off tWInteriOeclf r.

ee.ipientMatehes.:itiem.?),:1(0. 2. Notify poy§ier.Orr
The recipient is the same OerSori•narrioritin .fhis Rbod.tiimponentiTransiuSion

, Fotrn .60
4. do, NOT dicarck dell.. Re ti Idfdod , gag, Filter Set, oncli:V: sobtioris "to , the Blood
on the patient identification tag.
DESCRIPTION OF REACTIPN'

1st VERIFIER (Signature) . b)(6)-2 URTICARIA.El CHILL FEVER PAIN
oTHER'(SpeciM
13)(6)-2
13.1:0FIC.tig1§.401;iiiinnent,: clots, etc:)
YES (Specify)
PNh-I liANJnowc.nv
SIGNATURF OF PETiSCW;NoTING ABOVE
TEMP: : C.?:8•.PULSE 5)(61-2
DATE OF TRANSFUSION. TIME•STARTED

2:7N-Icr,9 Q3.6.. -
PATIENT IDENTIFICATION—USE EMBOSSER (For typed' or written entries . give: Name—Las! WARD
rate hospital or medical facility)
•

kW.* 1510 Ob OR BLOOD COMPONENT TRANSFUSIOf\
Medical Record
STANDARD FORM 510 (KV. 9-921
Prescribed by GSA/ICMR. FIRMS 1,11 CFR, 201-9.202.

MEDCOM - 5781
Medical Record Copy

DOD 12993

NSN 7540-00-634 -i 15`:
BLOOD OR:BLOOD"ICOMPONENT TRANSFUSION
SECTION 1 ,• :REQDISITION
7

TYPE OF REQUEST -.(Check;OfAili(Rad-BloOCr CO,.., REQUESTING-:13)(6)-2 -Products are requested:) .
2fig PrASNIA TYPE AND SCREEN DIAGNOSLSKQRRERVE PR EDURE
VP

CROSSMATCH "
(Pool of units)

ki,i0000115!%-rg (Pool of units)
.
kr.r.cDATE LI.EQpESTEgi I have collecteD a blood sPecirnen on the below ' : -tr./ .i..11. :0•1'.7) named , : Patient, verified the penie and 10 -- No of the
: •." "

Rh IMMUNE GLOBULIN .;;P-00111 and verified the label to be
. . •

correct:.. • ., OTHER (Specify) '10(6)-2
sour FORMAT ON/TRANSFESION'
KNDWNVOLUME REQUESTED (ifapplicabte)

L
REACTION (Spi9616.4
ML

REMARKS IF PATIEr4T FEMA' THERE HISTORY OF: . .
RhIG TREATMENT? ,a)..
TIME VERIFIED
HEMOLYTIC DISEAS RN?
SECTION FRE.TRANSFOSIONTESTIN
UNIT NO. TRAN 8 ON NO. TEST INTERPRETATION ANTIBODY SCREEN CROSSMATCH VREVIQLISREGOID OHEC -1:zpoao.„
Knri.TUillIP

PATIENT NO.

-)(49-.
DONOR
DROSSMAT6H-NOT. REQUIRED FOR THE COMPONENT
REMARKS': .

ABO
SECTION III RECORD OF TRANSFUSION
:POST-TRANSFUSION DATA
PRETRANSFUSION DATA

-c9MPLETED/INTERRUPTED ANO.issult:ty attiref AMOU T GIVEN 110001:
bX6l-2
BLOOD PRESSURE
REACTION,• • Wripr¦tE Li $uspigtfaj. _
If -reaction Is suspected—IMMEDIATELY:

DEMI 1 Alia I .•,...--..
. . ._ . .. . -.. '.. •• ..
1: DiSeentinUe transfusion, treat shock if present, keep intravenous line open.

form 'and- I -find all
have. examined the Blood ,Component container labelT.and this .form ,,_
I . .
2,.NetiN'PhS,Sicien sod TranifuSion SerViee.

. matches ' item, hi ifein:
information identifsnog.the,COOtainer. i ¦Vittithe:interidedvreciplent . '.
Felle.W, Transfusion Reaction Proceddres.

The recipient is the oorok*ook000le0;. 00.'this•BitiodCO.mponent Transfusion. Form and ..
on the patient iden.ti6taiioh tog.* . .. . • . .,. •:... -.. - .- . . . - • .• .._ .. •'.. -- ' -• 4. Do:NOT-dis.aid unit Return Blood Bag. Filter Set, and EV. solutions to the Blood Bank.

DESCRIPTION OF-REACTION

1st VERIFIER (Signture)
;b)(6)-2 URTICARIA CHILL Ei FEVER El PAIN

OTHER (Specify)
/

2rsi iFPLRFR'NfrsnAtrirel
,b56)-2
OTHER DIFFICULTIES (Equipment, dr:4s, etc.)

r--:. yE§.(,ipeoim PERSON NOTING ABOVE
/0_1-I 43* b)(6)-2
TIME STARTEDDATE OF TRANSFUSION

f WAR

ameos$pR . (FoEtijOidor written entries give: Name East, edical feeiliph . "
PAT!IDENTI
'
BLOOD OR BLOOD COMPONENT TRANSFIAVN Medical Record
STANDARD FORM 518 (REV 9-92)
Presbribed by GSA/ICMR. RRMR (41 CFR) 201-9 202:4

MEDCOM -5782 Medical Record Copy
DOD 12994

CLINICAL RECORD DOCTOR'S ORDERS 1.1%;e of this form, see AR 40-66, the proponent agency is OTSG
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MEDCOM - 5783
DOD 12995

CLINICAL RECORD • DOCTOR'S ORDERS
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101, 0.1.1,lL IF:CORD

DATE. TIME AND SIGN EACH SET OF ORDERS,
1 WHITE I F PROBLEM ORIENTED MEDICAL
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MEDCOM - 5784'-
DOD 12996

CUNICAL RECORD - DOCTOR'S ORt....--.S
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MEDCOM - 5785
DOD 12997

INIICAL RECORD DOCTOR'S ORDERS '
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MEDCOM - 5786
DOD 12998

CLINICAL RECORD - DOCTOR'S OMAR'S is For use of this iorM, see AR 40-66, the proponent agency OTSG MEDICAL RECORD
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MEDCOM - 5787
DOD 12999

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DOD 13000

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DOD 13001

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MEDCOM - 5790
DOD 13002

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MEDCOM - 5791
DOD 13003
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DOD 13004

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MEDCOM - 5794
DOD 13006

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OF ORDER
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(b)(0)-2
: • .. 4156 Eurrint! or; 1 .11.11.. 77. WHICH MAY HIS:. USED
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. .. MEDCOM - 5795
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DOD 13007

CLINICAL RECORD • DOCTOR'S ORDERS For use of this form, see AR 4W66.; the proponent agency is OTSG
THE DOCTOR SHALL RECORD DATE, TIME AND SIGN EACH S,ET, OF ORDERS. IF PROBLEM ORIENTED MEDICAL RECORD SYSTEM IS USED. WRITE PROBLEM NUMBER 'IN COLUMN INDICATED BY ARROW. BELOW.
PATIENT IDENTIFICATION DATE OF ORDER TIME Of ORDER LIST TIME ORDER
0-1,1 02.1, HOURS NOTED AND SIGN
b)(8)-2 D. b)(8)-2 b)(8)-2
rIP
(b)(8)-4

NURSING UNIT ROOM NO BED NO.
PATIENT IDENTIFICATION
mar

:bX0)-4
1111

X8)-2
NURSING UNIT ROOM NO. BED NO.
PATIENT IDENTIFICATION DATE OF OR ER TIME OF . ORDER
HOURS
)--7 63
'8X8)-4
row t 05-231) k, s
i n 7g
_ / • p o
6)(0)-2
(bX8)-2
NURSING UNIT ROOM NO. BED NO
b)(8)-2
d't
PATIENT IDENTIFICATION
111'3'w.
:bX8)-4
winrarionr

&11'Ammo
lelI MIRY'INMS

1111MiriEWri I
(8)-2
NURSING UNIT ROOM NO. BED NO.
EVIMMIEVYMIN

rismisett
b)(8)-2
REPLACES EDITION OF 1 JUL 77 WEt4.CFI'MA;
DA 4256
1 FORM
APR 79
•
•
MEDCOM - 5796
* • * •
DOD 13008