This medical screening form for a 37 year-old detainee complaints of chest pain when breathing for 2-3 weeks. Medical exam show contusions to left side of ribs. The medical records do not state how the detainee received his injuries and does not give any personal information on the detainee.
DETAINEE MEDICAL SCREENING FORM
DATE: 7#1"7
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bX6)-4
NAME;!:::[============L-_AGf: S7 HEIGHT: ~¥' YJEIGHT: (\"O
MEDICATIONS:'7h-+ nav.~~ Jq"" .-w+~..., ~
MEOICAl. HISTORY: 0 ASTHMA, 0 DIABETES, 0 HEART DISEASE, 0 TUBERCULOSIS, 0 OTHER INFECTIOUS
SICK CAlL;
OISCHARGE NO~NOCHANGE IN HEAlTli STATUS DATE: IS 7?!-1'] of
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MEDCOM -748
DOD 003811
CHRONOLOGICAL RECORD OF MEDICAL CARE STANDARD FORM 600 !REV. 5-8':
py""",,_ by GSA and ICMR ARMR 141 CfRl 201·45.505
FCAS V1.0
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MEDCOM -749
DOD 003812
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DriBade JlIrAeon
DETAINEE MEDICAL SCREENING FORM
DATE: r)1~11;z
b)(6)-4
L
NAME:'--________--..l AGE: S7 HEIGHT: ~V WEIGHi: (r:;-O AlJ.ERGIES: [J s... YES: ... ____""'(:4-"1~~....------------
NO ;;."'"'4-"V
MEOICATIONS:1J1,.....f rlrtl&~ ")1,,, .-I-~_ ~
MEDICAL HISTORY: o.ASTHMA, 0 OCABETES, 0 HEART DISEASE, 0 TUBERCUlOSIS. 0 OTHER INFECTIOUS
SICK CAll:
DATE 10MA.ru'I COMPlAINT / DXfTX
"??Jirlk) !.1ea brfJh /,..} V'Iy.e j fc416 (.'" :)/'1,oJ4
DISCHARGE NOTE: IJ NO CHANGE IN HEALTH STATUS DATE: ______
SIGNED: MEDICAL OFFICER: ___=-=......-::=:--_____ eClS, 91W) (Me. DC, MS)
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0" 046
MEDCOM -751