aclu-rdi 1081 p · 2019. 12. 12. · c. status.post small bowel resection and anastamosis with...

ARMED FORCES INSTITUTE OF PATHOLOGY Office of the Armed Forces Medical Examiner

1413 Research Blvd., Bldg. 102 Rockville, MD 20850

1.800-944-7912

PRELIMINARY AUTOPSY REPORT

Name: (b)(6)-4

SSAN: 10)(6)-4

Date of Birth: Unknown Date of Death: 24 May 2004 Date of Autopsy: 1 June 2004 Date of Report: 1 June 2004

Autopsy No.: ME04-388 AFIP No.: Pending Rank: Civ Place of Death: Baled, Iraq Place of Autopsy: BIAP Morgue

Circumstances of Death: By verbal report, this Iraqi male was shot in a firefight and lived to be transported to a US hospital where he underwent multiple surgeries but died due to complications of his wounds.

Authorization for Autopsy: Office of the Armed Forces Medical Examiner, IAW 10 USC 1471

Identification: By prisoner number only, DNA sample obtained

CAUSE OF DEATH: Gunshot wound of the abdomen

MANNER OF DEATH: Homicide

These findings are preliminary, and subject to modification pending 'Water investigation and laboratory testing.

MEDCOM - 962

DOD 004025

ACLU-RDI 1081 p.1

AUTOPSY REPORT ME04-388 2 b)(6)-4

PRELIMINARY AUTOPSY DIAGNOSES:

L History of remote gunshot wound of the abdomen A. No gunshot wound defect or tract evident due to multiple surgical

interventions B. Direction of wound indeterminate C. Status .post small bowel resection and anastamosis with sigmoid

colostomy, and rectal stump • D. Feculent peritonitis (300 ml of pus and feces) and fibrinous

adhesions E. Right pleural adhesions and bilateral purulent pleural effusions,

status post chest tube placement F. Pulmonary edema and bilateral pneumonia (right lung 1150 grams,

left lung 1000 grams) G. Purulent pericardial effusion (SO ml) H. Minute radiopaque fragments visible on sub optimal radiographs,

no projectiles recovered

IL No other significant trauma Toxicology and histology pending

(b)(6)-2

r)(6)-2 I MD MAJ, MC, USA Deputy Medical Examiner

a MEDCOM - 963

DOD 004026

ACLU-RDI 1081 p.2

C.) 3 (b)(3)-1

04.1. 1

.;2 I.

EitiNA obx6y2

(Slot* disease, injury or /Attrition whish caa Ie•• N.• hour

earl failure. ate rine death.

CERTIFICATE 0,F DEATH (OVEkSEAS) Acte de dec.ns (D'Ourreniger)

:b)(6)-4 o 11.am NAL ASSAY I Holy. au etiea.ki Wk. or amainornol GRADS Grace ER ...NCH OF SERV/CI SOCIAL GlIculiirt muusith • Ain. Hun.i.. tH t• Anwar.. Soci.•

ORGANIZATION Of makation NATION (.a.. Volume Slyne.1 DATE OF NINTH

• . P.I. Dine de •■•■•■•••011

•

SIX S... o HAAS le.aavuo ' ❑ PEreALII •4NanIA

• RACE R.C. MARITAL STATUS ElsaEae2 . RE UGIOIN Culls CAUCASOID c...entee. SINOLE CAIbauare DIVORCED Shwa Ito PROTESTANT . Auve (Speedier. OTHER *Spicily)

• NEGROID N4prOldt MARRIED Merei ' CATHOLIC Cake/Gave •

. JEWISH Jail Avue (Tplefaeri - WIDOWED Vow Siseri OTHER ISeeel NI • SEPARATED ... •

NAME OP NEXT Of KIN Nees au Oar kerb. ;poem • IONSHIP TO Oece.seo p...1.i a. ai.d.s............a. .. A. STREET ADDRESS DenEekg 1110._I• CITY OR TOWN AND STATE IlneIude ZIP Como) VW. ICada 0....N aaN.A.1.1

./.. • MEDICAL. STATEMENT '0Z•Eamian .1:41./.

.... • CAUSE OP DEATH MN NV *WV feu a.m. pH. IMO ONSET ANC? DEATH Calm EN Gierloil ltrInellSour qu'wle um./ fret Hanel IsHaryallm env*

INTERVAL elYWIIIEN TallaGen.. le kieioi

DISEASE OR coNDITIOm DIRECTLY LEADING TO DEATH' AmaNue/ as eenrEtlen Wove amen/ respenanale ea la mart '

ANTECEDE • i MO ma I 0 CONDITION. IP ANY, LEADING TOPPI/AA/1Y lam. R; • CanDIEOn morkide. Vil V II lam. 6 .5" Su, 4./e ""iLtc1-6 .-.1411j

CAUSES.{' nowien I li I. eau. Damage M C4LaS+.4"..e.

_._._,..-Dea---'(• • .111.401ERCY.18113.CAU5d.ar ANT. ..r.........• el Vsna RISE TDPrumAnY - • • •. Ralson lenterneetola. s'Il y r 0.... ... . ..

de la awl.. • CAUSE . • - Wei AvAle■ I. caw* Pruni. • • .

. . . . . OTHER SIGNIFICANT CONDfTIONS2 IA .

arm eoreations esnirseetiv**2 •

MOO II OR DEATH • AUTOPSY PERFORMED Aurterwle .1 euvie 0 YES Ou. 0 NO MOE CIRCUMSTANCES SURSIGUNOING OEATH DUE TO EN TaRNAL CA LO OS Canal Km de eke. 4A4011 FINDINGS OF AUTOPSY Ca.....ioas prinaloaNa ea I'. earreN Cleaansaamaes da le .nek ....I... ear kw eau.... taitearaa

•• a • •

•

Lien =caws rim

I NATURAL Mart na1.1.114 . ACCIOENT

SuIdea SUICIDE MANE OP PATHOLOGIST Nem ea paae.ealue

li•erMele. moiecioe SIGNATURE SIgnamore .. DATE Dale .

AVIATION ACCIDENT Ateldant i Avian • 0 vol ow ' ❑ NO man

Demme pd. ire...... le law. I. me/, ranAaHl PLACE OF DEATH Li.. RH eve:. DATE Of BEAT. (Noun d.y.....nah. reurl

• I HAVE VIEWED THE REMAINS OP THE DECEA9S0 AND ONATle OCCURRED AT THE TIME INDICATED AND FROM THE CAUSES AS STATED MOVE. .Vai nave/Ace. non r.arle/* ./. AS Hans . I. cameos aa. fill 44/11 wIll We MI / rbmw. LodisweLs et 1 la wire dez csual. finueeifias ciAlenea. NAME DP ) • • •-••••••••••• .- - -" •-• - " '-- - reedkin senake

LIP Crh/ M C. TLE

.

/O

Tim ma uleia.n.i

'7

MEDCOM - 964

DOD 004027

ACLU-RDI 1081 p.3

/2 4-4 /el/ 1 Id LEGEND HOURS .24 01 Rs pig- /sir •C - , 4?

PAGE 4 OF 4

NEUROLOGICAL ASSESSMENT

1./

• SP:417 01EOUSLY 4 LL • 7.) SPEECH 3

PAIN

• :i0 EYE OPEWS4 1

C Closes by walling

y <of ‘t

1!/.141- Lt 1.4; 9 kf; 4,

• 2 • 3 04 0 5 0. ® 7

-r Brisk

+ Slow

No — Response

+ Intact

— Abnormal

RIGHT

LEFT

t2(

REACION

SOS

RE ACTOR +/- FJPIL SCALE

ICP CEREBRAL PERFUSION

PRESSURE

HOURS

j GRANTED

CONFUSED 4

VERBALIZES I,- 0

E k VOCALIZES 2

• VOCAI.ZATICR I ✓ Jry ✓ ./

vsolEsen

SSitun^g

O DIsahava

R Recepwa

E Ea•rivve

C

C

C

:BEN'S CDMALAN3S I OCALIZESPAW

FLEXION WITHDRAWAL

AeaortuAt FLEXION

EXTENSOR PL:c

• RESPONSE

6

3

2

2 a

NORMAL POWER

1.7L7 WEAKNESS

SEvERE ASAKNESS ✓

:3;40Rt.IA:. FLEXION

ABNORMAL EXTENSION

NO RESPONSE

4.0

R ROI

L Left

Record Separate; there .s a Deference between the

tow Wee

Y E

E N

NORMAL POVtER

:ILO WEAKNESS

SEVEREIASAKKES

kelNORUAL FLEXION

A3NOR1AAL EXTENSION

RESPONSE

,0

VASCULAR ASSESSMENT

FIABEREMEMINNE► AIM NOWANWOMMINOWIMS WANNWANWANNSM► NWA

+ + Normal

+ Weak

Absent

Doppler

Right

O

MEDCOM - 965

DOD 004028

ACLU-RDI 1081 p.4

DAILY PATIENT LAB VALUES

DATE/TIME DATE/TIME DATE/TIME DATE/TIME DATE/111E DATE/TIME DATE/TIME DATE/TIME

CHEM Ou igl 11 REINZ TEST RESULT RESULT RESULT RESULT RESULT RESULT RESULT REF. RANGE

ALB 1. LP i i g 3.34.5 gML

ALP 94' 53428 U/L

ALT "7-L1 ro r 1047 U11.

AMY Li 0 14-97 un.

AST 6t ai ?r, 11-38 UR.

Tbil 7i q 7.110 0.2-1.8 mgldL

BUN i A'', i 7-22 mem. Ca Q . 3 • 8.0-10.3 mgldL

Chol I rn 1117 100-200 mgldL

CK 39-380 U/L

CL 98-108 mmoYL

TCO2 172 18-33 nanoUL

Creat I,D( /slid-) 0.6-1.2 mg/d1.

GGT 5-65 U/1.

Glu -3- I `9/1 73-118 mgldL

K la • q //, cf 3.3-4.7 mmo1/1.

TProtein 'I, 2. 4, 1 6.4-8.1 g/dL

Na I r13 / '3 128-145 mmoUL

DAWJTNII DATE/TNN DATE/TIME DATEMME OATFJTILIE DATERNE OATETME DATE/TNE

HEME TEST RESULT RESULT RESULT RESULT RESULT_ RESULT RESULT RESULT REF. RANGE

WBC 13. Li 4.840.8 xi 0(3)/uL

RBC 3.Licr . 414 . .4%. 4.2-8.1 ic10(6yuL

Hgb 10 . 7. ' ■. . , "1 12.048.0 g/dL

Hct A,7-."3 . . I 7 35.040.0%

MCV q i,q. r , 80.0-09.0 6

MCH aq . LI 27.0-31.0 pg

MCHC 1 1.5' . 33.0-37.0 g/dL

Plt 111. 130-400 xiopyuL LY% It . ("1 15.0-50.0%

LY# 6 . 9 0.7-4.3 x10(3yuL

DATEMME DATFJrNE DATRJIIME DATE/TIME DATEMME DATE/111E IWIFJTILE oATErrae UA i

TEST RESULT RESULT RESULT RESULT RESULT RESULT RESULT RESULT REF. RANGE

Color tre-t' ,• Straw/Yellow

Clarity VALY — Clear

Glucose ti.t-1) . p Negative

Bilirubin 204• • ' • ii* , 'F Negative

Ketone tib• SG

Reit 1.030 ( 1 I 1.010-1.025

Blood Ii 04174. 41 Negative

pH $4 54 : VA 5.04.0

Protein I 4 Negative-Trace

Urobili 0•. Negative

Nitrite NOC.• Negative

Leuko torec, . Negative

Q MEDCOM - 966

DOD 004029

ACLU-RDI 1081 p.5

LAST NAME FIRST NAME MIDDLE INITIAL ID NUMBER

DATE NOTES

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C) / 46 C5i . ARD FORM 509 (REV. E11999I BACK

(=PA VI.00

i n MEDCOM - 967

DOD 004030

ACLU-RDI 1081 p.6

AUTHORIZED FOR LOCAL REPRODUCTION

MEDICAL. RECORD CHRONOLOGICAL RECORD OF MEDICAL CARE

DATE SYMPTOMS, DIAGNOSI TREATMENT, TREATING ORGANIZATION (Sign each entry)

zil5cialL 1

e c. 7 • ,5 P tu-e-

': 3f i 23 I.

/7-1°1 P th/P1 ,4 Vavi ,- .0 0 e (J- 4-. cis (;.• I

g •-■-..i off r ei. 6 i-t... fizs5); ‘.' 7/7'ir •t 500 --, IL lioe4. a efe.43fze ip -1 4.,- /le 4" ci ire /

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4 P 44 ft ekA:i J . w: /(c.,....ii,..e. A, e ...), plc...

uf //../116 444 4,fel

D )zer

typed or written entries, give: Nam - last, first, middle; ID ale or SSN; Sow • la of Sir h; eank/Grade.1

Jif (efeJ A ‘3

STATUS DEPARTJSERVICE RECORDS MAINTAINED AT

SSN.ID NO.

)3)(6)-2

WARD NO.

RELATIONSHIP TO SPONSOR

11 MEDCOM - 968

.111■110MEMIIO,

REGISTER NO.

U. RECORD OF MEDICAL CARE Medical Record 2ORM

000 (REV. 6-97) .

iSA/ItI414 31201.9,202-1

LAS

OSPITAL OR MEDICAL FACIL

*ONSOR'S NAME

‘TIENt 5 IDENTIFICATION:

V2.00 USAPA

DOD 004031

ACLU-RDI 1081 p.7

CLINICAL RECORD - DOCTOR'S ORDERS For use of this form, see AR 40.66, the proponent agency Is OTSG

THE DOCTOR SHALL RECORD DATE, TIME AND SIGN EACH SET OF ORDERS. IF PROBLEM ORIENTED MEDICAL RECORD SYSTEM IS USED, WRITE PROBLEM NUMBER IN COLUMN INDICATED BY ARROW BELOW.

PATIENT IDENTIFICATION 10ENTiFICATION DATE OF ORDER TIME OF ORDER

-PI I N''‘b -'-‘ 115 45 HOURS

LIST-TIME ORDER

NOTEDSION AND

--1/4-ti 3mvobiL 6)(6)-4

eozD beexo.%

NURSING UNIT ROOM NO. BED NO.

PATIENT IDENTIFICATION DATE OF ORDER TIME OF ORDER

HOURS



HOURS

NURSING UNIT ROOM NO. BED NO. •


HOURS

NURSING UNIT. ROOM NO. BED NO.

DA IFAvn, 4256

REPLACES EDITION OF 1 JUL 77. WHICH MAY BE USEO.

U.S. GOVERMENT NONTR40 1916-40••124 ■■••■ •••••,.

1 MEDCOM - 969

DOD 004032

ACLU-RDI 1081 p.8

PATIENT IDENTIFICATION

%)( 6)-4


6)(6)-4


b)(6)-4

CLINICAL RECORD - DOCTOR'S ORDERS For use of this form, see AR 40-66, the proponent agency is OTSG


NURSING UNIT

C■

ROOM NO.

ROOM NO.

BED NO.

RED NO.

P

UST TIME ORDER

NOTED ARO SION

rr. • tee it. 047 442.-eat rl

)\ 0.rrAJDA6~N— se r/e—c--- ft/ fes.

ser csS e c. Ca.bi, ti - JL 4 24o c._fr,

tAtideripto --, COG — DAT OF ORDER TIME OF ORDER

HOUR*

erie, J eje*. a drir (J t -41 "TiOsmof..,

gm.. t 2° ertot) 3456 WI 6 6-

4 Ce- CiOk.

DATE OF ORDER TIME OF ORDER -.- 2o UZI" .2..2-d OURS

NURSING UNIT

14-0 DATE OF ORDER TIME OF ORDER

HOURS

.."(\r/c)i. Ifirklit. 67) r Os .c 1f7 **IS. A.AJO *tut 24 Ls tAr

%•■-..,gerSC2 I. b

okik V.- 7-V -* re°

NURSING UNIT ROOM NO. 8E0 NO.

1 ci DATE OF Ot,-.

ti6A.U1- 4,5j CX,_

\ COL e"

\1301 .1‘Vz C


NURSING UNIT. ROOM NO. (SQL, 'Le BED NO. Aok< C. c."

DA f FORM APR 79 4256 R AC141041pN OP 1 JUL 77, WHICH MAY b)(6)-2

et w

° .2/ AA-yp-If

1 MEDCOM - 970

DOD 004033

ACLU-RDI 1081 p.9

PATIENT IDENTIFICATION DATE OF ORDER 'TIME OF ORDER


;b)(6)-4

DATE OF ORDER TIME OP ORDER LIST TIME ORDER

NOTED AND SION


b)(6)-4

b)(6)-2


DATE OF ORDER TIME OF ORDER

r 1.(1>f C')

VI) Ir hole_ 2. (Am c


k rs

(5.) / C I v. 04P4' .'"

b)(8)-2



2°k)1 4. 10

e'rt—iteq —igr,faxxWe ( x. re — 1)

eb c4,

s.40h- 147 AO p 1

b)( 0) 2 NURSING UNIT' ROOM NO. BED NO.

DA I FAVA79 4256 REPLACES EDITION OF 1 JUL 77. WHICH MAY SE USED.

CLINICAL RECORD - DOCTOR'S ORDERS For use of this form, see AR 40-68, the proponent agency Is OTSO


1A

MEDCOM - 971

DOD 004034

ACLU-RDI 1081 p.10

CLINICAL RECORD • DOCTOR'S ORDERS For use of this form, see AR 40-66, the proponent agency is OTSG

THE DOCTOR SHALL RECORD DATE, TIME AND SIGN EACH SET 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

•••• 91 -f261-- HOU ' NOTED

SIGN AND 1))(6)-4

C /A / 4

$ , . x r _m.o.-

b)(6)-2

NURSING UNIT

1 L J ROOM NO. BED NO.

011°

PATIENT IDENTIFICATION DATE OP ORDER TIME OP ORDER ..-

/(441j- 2,-,apir 4 HOURS b)(13)-4 It

ft OC It- 41. C----- r ..., a f

C 0 P.75.frdr I : /

40,-- 4 Ay .r /a At!)

fee e V. . e 4,1, 145.5 /1114v LOG Y : ,

0 5}rs,-7 4v- 1 6 e."7-i I NURSING UNIT

? C- a ROOM NO. BED NO.

Iki . i A 471; A iskti . , PATIENT IDENTIFICATION E OR 11 Ill

% Oar 6 0 Nouns p, tiN b)(6)-4

AL chier/J 2 s 7. Nos itix.,-, : b)(6)-2

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NURSING UNIT

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ROOM NO. BED NO.


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C 1 V C I F s.. ...,-

cici 0 c.„: tuaT /70 IQ d 2c 0 C ci A (..a. roio n A. 3 d

NURSING UNIT

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ROOM NO. BED NO.

3

± 0 - ; : I 5%) 771- \ k

I- 6 e ,,e...1 JUL .1.4,‘

.....hi,

DA FORM 4256 REPLACES EDITION OP 1 UL 77. MO MAY SE USE

. r-

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)(6)-2

MEDCOM - 972

DOD 004035

ACLU-RDI 1081 p.11

COMPLETE APPROPRIATE ORDERS WHERE INDICATED

8.5% AMINO ACIDS ( ✓ ) 4.0 kcal/g)

LIPIDS ( ✓ ): 50% DEXTROSE (3.4 kcal/g) (I): VOLUME (i ):

/, 1 Liters / day = 125 ml/hr . . ...........— .....—..... _

Other

Standard Central a initial dose 150 gm/L; 510 kcal)

4.etandard Central a maintenance

( 200 gmlL; 680 kcal)

• i Standard Peripheral's maintenance (85 gm/L; 289 kcal)

Other = gm/L

J 10% at 21mL/hr (550 k ; standard)

OYo at 21m1 ../hr (1110 kcal)

7.! 20% at 41 mL/hr (2016 kcal)

108/ at raLthr ; 20% at mL/hr

tandard Central (45 gm/L 1180 kcal)

LI Standard Peripheral (30 gin! (120 kcal)

Other = gmIL

1 Liter / day ■ 42 mL /hr ratel

2 Liters I day = 83 mL/hr (adult; maintenance)

:b)(8)-4

• • -- 11CPORt TITLE

LT PA RENTERAL (TOTAL AND PERIPHERAL) NUTRITION ORDER FORM

C HECK (1)

APPROVED

to May not want to exceed 100 gm/L of dextrose in PPN due to increased risk of phlebitis

ELECTROLYTES (✓ ):

DAILY REQUIREMENTS

TANDARD . INDIVIDUAL

Sodium: 60 •160 mEq 40 mEq/L mEgIL

0 mEgIL

Potassium: 60.120 mEq 20 mEq/L mEq/L

•

0 Calcium: 10 .15 mEq" 5 mEq/L

8 mEq/L

mEq/L

Magnesium: 10 - 20 mEq mEq/L • Phosphate: 15 - 40 rnI1,1" 7.5 mMIL mMIL

2 mL 2 midday mUday

10 mL 10 midday mL/day OSA() WAD QSAD •

ADDITIONAL MEDS ( ✓ ):

1 ADDITIVES (✓ ):

Vit K. 5 mg SQ weekly or ___IM now . .11 . . /117,71c Aci :11:1011, .ay or. nig I day 11..irl9nitidlne; - .

Hydrocortisone: 5 m g/L (for PPN only) . . Heparin:_ U/Liter

. • Other: • . • • ::

insulin: U/Day

150 mg or . mglday . . Cimeti qrliw x, r _mg/day

i Other:

Standard Orders To Be Transcribed: 1. it central (TPNI, check for central line placement - STAT CXR ...... ..... ..... ....

2. Consult to Registered Dietitian AND Pharmacy; forward copy of TPN orders to Pharmacy

1. 1 1:0 TPN Ime (distal port) tar TPN only. 4 it I PN imtrinitren, hang 010W at the same rate for 4 hours or until TPNliM-atanied.

Sind 13 Vs. •adY wiliLIIIIS VS A Inil l i lllll Ili of q 8 hours. call physician If Tamp !1St 5. limens ick Diocese q 6 hours; call physician it 3. 200,

8. CPiern 12. PO4: Mg "4°^4ars1.2.anci 3; and then q 7 days; do c

••

7.TrIglycerides on day 1; and then q 7 days.

9. CHC/0111 (automatic), PTiPTT on day 1; and then q 7 clays

'10. 24 -hour CNN on day 7; and then q 7 trays

11. Other

START TIME:

;1:. Prilltili4 New alders m chattgaa to existing.; orders should be received by 1300 hours. in extreme cases, changes will be made °mei than on the day shill .

b)(6)-2 ...- PHI:PA

• .,/

ft,nninnh, cui /O. 0.., ....

e: Name

DEPARTMENT/SERVICE/CLINIC

• if the i -lest,

I DATE

/9 4//zatir

• :11 OW I

FILER EXAMINA I OR EVALUATION

0 DIAGNOSTIC STUDIES

3,X6)-4

01'111.1r

MEDICAL RECORD•SUPPLEMENTAL MEDICAL DATA 1•,0 0,•1 :0 mis loom, sue AR 40•68: the proponent agency is the 011ice 01 The Willem Genisid.

— - ..- - -- . . — — -- ---- --- — ----- .-- -- — -- ._ — — — . —T. So. A-PPkOVED - 0 .1).n.,, 1

Sodium Chloride

Sodium Acetate

Potassium Chloride

Putassint Acetate

Gluconate

Magnesium Sulfate

uutssswin Phosphate

trace Elements

MVI. 12

Sterile H2O For Injection SPECIAL INSTRUCTIONS: TPN must be filtered using a 0.22 micron filter. Lipid infusions must be filtered using the 1.2 main Inter "7-Arnouriiii .Giiouin 41.41,110ms will be dependent upon solubility. See reverse side for how to ea/co/ale a TPN.

1g MEDCOM - 973

DOD 004036

ACLU-RDI 1081 p.12

DAILY PATIENT LAB VALUES

DATEMLIE DATEMME DATFJT1ME- DATF.JT1ME DATE/TIME DATEMME DAIF.MMEDATFJTIME

r LfIriliiii11131 LQIETkik1lif1 rz 00 TEST RESULT RESULT _RESULT RESULT RESULT RESULT RESULT RESULT REF. RANGE

ALB 3.3-5.5 fot. ALP 53-128 WI. ALT 1047 UI. AMY 1497 U/L AST 11-38 U/L 71311 0.2-1.8 mg/dt. BUN %I 23 7-22 rrig/di_ Ca 7.t 7 4 late i 41 i's 61 IQ. t. 1k (-1( " 8.0-10.3 mg/c11. Chol 100-200 rrtg/dL CK .

39480 us. CL it/ 101 98.108 nmol. TCO2 27 2 5- 30 -14 n - 1843 ninoUL Creat 0-r 0-Y _ 0.8-12 rrig►dL GGT PA 545 tut-tut-/ Glu 21-1 IS(' 73-118 mg/til. K 3.3 3.1 3.5 3.4 552 S - 4 3.34.7 mmotil TProtein 8.4-8.1 g/dL Na r lir 14 0 144 _ !kg 147 Oa 128-145 newt&

DATEMME DWANE DATEMME DATP/11E CA1V1LE DMETIAE DATEITSE DATFJTIME

HEME TEST RESULT, RESULT RESULT RESULT RESULT RESULT RESULT RESULT REF. RANGE

WBC 134 13.1 I4. 1 ii-r 124 I, 4.8-10.8 x10(3)/uL 4.24.1 KuoyuL RBC 3.0$ 2.4% 1.c., 3.31 4 -to

Hgb q.1 7•Z 17 il ro. I pri 11.- t.7•t 12.0-18.0 e a Hct 214 23.4 liq at 31-4 33 lit M.0 35.040.0% MCV 1 41..1 t/It.7 -

w ' 10) *hi 131 7.57 15.1 80.0.99.05 MCH nit 21-1 ..r..1--7 ).t.4 3p. s' go:, 12. 2 tol, 3I-7 at.6 27.041.0 pg MCHC SPA 30-7 eVz- 12.0 IDA 44- Pe 2. 14 Pot 47 ii- 1 33.0-37.0 WdL Plt 30 sll pi, c5" 3.2 PS' e, 14 1424 aS 33a 130-400 x10(3)85. LY% &•l 4.11 kW% 2 0 S a 516 bEr II 13i. 6' ,.r 15.0-50.0% LY# OA li-ci Su t3 D. 8 . 0.7 Shill 941401 o Or - 0.7-4.33[10C3yul

OATIVIE DATE/1110 OME/TIME DATUM DAMS* MIME memo ., DATUM*

UA er- 6 TEST RESULT RESULT RESULT RESULT RESULT RESULT RESULT RESULT REF. RANGE

Color lis sa Strearfellow Clarity _ ell" 7 Clear Glucose Airtari) Negative Bilirubin

sc•o 41 Negetive Ketone Negative SG 4.0r>> 1.010-1.025 Blood _ AM Negative pH r n 1.(8 5.0-8.0 Protein lie01.3 Negative-Trace Uro13111 p t• 4 Nitrite 14 NI) V/ Negative Leuko 3i. C.' Negative

b)(8)-4 ,

17

MEDCOM - 974

DOD 004037

ACLU-RDI 1081 p.13

Hct

a ______ _149 nnol/L

__________4.5 mmol/L

CO2___ 30 nnol/L

Ca_______1.19 mnol/L lct_ 24 %PM,

ib*_______ ___e g/dL

*via

SamP l e Type.:

21FEB04 10:04

mmHg

mmHg

an01/L

aa014.

At 370

• pH_ 7.118 ▪ pCO2___ _81.4

-74 HCO4 --__26

502* __89

*calculated

1Q MEDCOM - 975

DOD 004038

J.711S3e1

24620

JAHSO47A CLEW A94

1-r-Trand —i7f-TSW-

1-4 Hoe 9-h WO

-)qt: oral 14C4IN

non eralald

Hd P0018

OS OU010)1

uler-►1118 amino 411319 J0103

1S31

VA &WO

OHO HOW A3141

4614 0911 38M

1S3L

vraH sfausivo

eN upecudi

no 100

3771

7.Iwalva NINILIRLVa WILL/31Y0 3•111.111V 0 IVtUILVO

...•••••••■•■■■■ ••••■■•■•■■•

Oper:

Phys .

serif

Yen:

- - - - - -STAT E67+

1 b)(6)-4

t Hamel

It 37C

2H_______7.103 no2 86.9 mmHg

P02___ __et mmHg

HCO3__ 27 mmol,L

BEecf -2 mmol/L

502* 90

*calculated

--------_-_-_----------- i-STAT EG7+

rb)(6)-4

Pt Name: _____

Ha ____149 nnol/L K__ _ _4.3 aa01/L

TCO2____ __27 nnol/L iCa_ —1.17 nnollL Hct __ES XPCV Hb*_ 8 g/dL

• *via Hct

Type_i

21FEB04 10:09

Oper: 1771

Physician: ___

i-STAT EG74

1.4 Pt

Na____ ___148 mmol/L K_ 4.1 mmol/L TCO2___ _28 nmol/L iCa 1.13 nmol/L Hct___ 20 MICV Hbo_ 7 g/dL

*via Hct

At 37C

pH_• 7.242

amH9

POI__ _73 mmHg

Hc03 26 mn01,L,

Mee_ ---1 mmol/L 002* 93 %

*calculated

Simple Type_:

21"2504 11112

Oper: 3771

Physician:

Seri 241520

Vera JAM5047A CLEW A54

'maw+ 00Viret

IPAVelre 11041411 CIP-C1 113/13w in

ynsal -true! a, ri.ern

clan:_____—

sbywavu

S5 '

#A1 %Al

Sort 24520

Ver: JAHSO47A CLEW A94

ACLU-RDI 1081 p.14

IC R uTT.7i' • : 27..117717— irrT .

1 11111111 1 1111r !lair int arm

. III • . . • -

77.47. • „. . • .

WM 714b4441.4224

EXASIINATIONIS) REQUESTED. MOISTER NO.

PitiONAKT 0 YES t4°

Mather IRADIOLOGICCOMULTATVN REatfithaliFORT

,,111 -r, •-

b) (6)-2

. ••,......

••• •

. - . • • • • .• • . -

. DAT4 REQUESTED

• [ vt4Aer4r •

AR0/4XJFIIC

. "•

: . •

IrTITMICLATI=laitinglivrisvINNK imam

qixacorramqp memair-JuscostRor

.• „ . • •••• . . . • •

LOCATION OF outosaiosic FACILITY

1

MEDCOM - 976

DOD 004039

ACLU-RDI 1081 p.15

b)(6).2

DEPARTMENT OF THE ARMY TASK FORCE ALCATRAZ

PRISON HOSPITAL ABU-GHRAIB, APO-AE 09342

22 MARCH 2004

SUBJECT: Check-off list for patient transfers

Below is a list of items that MUST be completed in order for the TOC to get a patient transferred. Once these steps have been completed TOC personnel will make the proper arrangements for the transfer to take place.

b)(6)-4

Patient identification:

Discharge or transfer order complete: Dr. signature/ b)(6)-2

Doctor-Doctor update complete: Dr. signatureldate/tim

Nurse-Nurse update complete: Nurse signature/date/time

Mode of transportation requested: Air 7 Ground

Priority Level of patient Urgent Non-urgent

MP Guard required: Yes No ✓

****If any item above is not applicable place N/A in the box and initial.****

**limy special equipment is needed for the transport please list items required below** Porta& ge.

vedt 4.6+• •

(b)(6)-4 ********************************************************************

TOC Personnel to complete items below this line:

Patients records copied: signature/date/time:

Transportation requested: signature/date/time:

Time patient left Alcatraz: '"Pe4t dirjL-

A rt: p-cUr ift 0=9

— • .

9n MEDCOM - 977

IV; - 4'5

e•14-It>--A

DOD 004040

ACLU-RDI 1081 p.16

T

T

BP Arterial line

BP Cuff

7ernperatee

Pulse

0.c.sPr•si. DAV 24

vo Egramrar

.111

T TOTALS

91 MEDCOM - 978

DATe 021

TIME 14

I.

S

G

N

S .

A

Respiralort Rise

6"( or Inietrf nuta 24 01 02 03 04 OS 5 06 4.ebd-Cier4F1-71 EIVIVARRI ° 4ukffillii=1110010k41111111 REIFIREIV '0% 1111=1111111111111221111111111111M21111111111,72

lagorigErnim ENE" 3 4 Wig. RR

08 09 10 11 12 13 15

02 03 05 06 07 8°T 08 zo dot)

5

TIME

13,01444_ .&2p4.4--■

11114 et4:4-■

A

04 09 10

TOTALS

URINE . FP y

SA

K

E

9

U o'-UT

NG

GJRC

NEM

STOOL. P

- is U DIMS

N

DOD 004041

ACLU-RDI 1081 p.17


MEDICAL RECORD PROGRESS NOTES

DATE NOTES

rnotA, t-/ Ivrzw. I' iy, Pr otflettu e-. P- r twiln qs Iltri-L.10

Og'o

Gl., Oa Pr flow- r6-hrc6 eeautue_tAA, vs- 6.1e3( Pr sf,prai-rcLi, Irelctri 6_1, 5vo-/kA P r on ve a+ - _5 1 rnt% mole . Tye- sto, rt. 06)(21 A' V 1 0 . e_zr

- El' 211 crtk . 155 -it) c.d.( L1,0 11.0 , eifi- . 414t • 1214S, 4 , . 0144, Pi" ,/1--i-v.t>1 / , t 'Putt ilekk.PC ;o rs .

(

20 - i 5

(-Lex+ V-r hat) 0A4kvku. ro (II 4 rre,51suAt3_stekne.-cd-e Z . 6

&Lt Xircroki-u,N CIF) 12,S x LI kpci- om.u.xc,v1

11 -11'll Ceiec NDA,41p nirp aka

oAe, I x- cr tif3

ikAGk. (...,(01.6t,rad ivniv) 41,4 ri8 :it as to I AA it hao jleo%

f Iv P La. sl-Tromk. (3.9k-x.a.A-- filscm 0- (trifia 11k _1r fr1,CLL &nil i Ireg fmck i-( IA it( uvt k (16-trii iY) 1}; \lot . Ok .i-rmA.t-3 I-6 UR) , 4.siviv\ex. V 1- rylivA ofiAkAid eu mom LIA Li ) rIel Akk 11 m0 (1,,ti • pii,ure ra Fir 1-c IAA , '

(Mk 'OA

(

LATIONSHIP TO SPONSOR SPONSOR'S ID NUMBER ••:

I RECORDS MAINTAINED AT PART.1SERVICE HOSPITAL OR MEDICAL FACILITY

IENI 5 lOtNril-IcA NON; 1T-or typed or wnrion anular Nemo • Mel. arS4 "NNW OT Na aa SSN• Sow Data al Meth; Rank/Gredol

REGISTER NO. WARD NO.

PROGRESS NOTES Medical Record

,b)(6)-4

STANDARD FORM 609 Inv. en sem Proscribed by GSMCMR FPMR I4ICFR) 101.11.203Ib/110)

U5APA VI.00

99 MEDCOM - 979

DOD 004042

ACLU-RDI 1081 p.18

fl

........ 1

1

. . i I I - , ! 1

, •____

r

1 1 1 t„ ,,-i-,-,p

; _

i IA . L . : 1 kle4lf:P ,, , -;! 0- 1_, il!II.N-qiii

-

s :,;.„,.,.

-. -I.

%-' icic-, p)

1,0-,-. D

AT

E/T

IME

: MO

DE

-6 I N

V

(V]

,

■ ('sl.4. t • r• ' • %. • t

• lia 0 ' 174,

.

,(:)

a. t.1

t A Z.

TO

TA

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.

I CI (ik Ill .... .... .... •••■ •••• ..... .... .... S. .... .... .... .... .... .... .... "S. "... .....

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I 0 / I /

,

1

I I

sa / s.

AL

AR

M I

S-O

/3 I

.5-z) 5-- 1

ts-D

'rot

itir! Ve

y ; \ ci C.,) N v

.`;

Sirva(

1- • -

/ r

11/46

_

x 114 S

7 10Y

-4

_ 111-ed

,u_ ̀rfr

. ..

CO

MM

ENT

PT &V

ic/CD fP

-ox f (

err kt OCTI1P

22 b

/.1.eix

iv 00,-) T

AC

511 61011-1.-

c9r-- MO

D T

l-/ tCk

_. . .. . ..... ... .. .... 1--.-

1

■ .

-

MI

i

..i .

il 1

1. t I.Z.

I 1 ( b)(6)-2

9q MEDCOM - 980

DOD 004043

ACLU-RDI 1081 p.19

:b (0)-2

AUTHORIZE) FOR LOCAL REPRODUCTION

MEDICAL RECORD

PROGRESS NOTES

DATE

NOTES

&Li /1..1 C, o 0(;,4,;, ..647=44. "ma 9 04,

X .41,;4coiv ebrli 11,1144t... 414/4n rt.-A/L.4'34- ce,u, pea. post4414.6 ti-uce0.41. punki

11,b4s,4% iv-, aN.C44‘..0.:, 4:geig.;

Pe42kh-i gi‘iil,tivt44..;. 4ury 2r. isAt.ote.,

A-64-z-4 02444.1

0q 3o

)(6)-2

14;44.44

b)(6)-2

Rzstw..v.c. 41-A4`14---

(0)(6)-2

SV,,b 2\ 0_,„cNN

tn

(2.-‘

iNt4) coliz)ckti

Crl-a- r.D-- cer>

ATIONSHIP TO SPONSOR RPAN SPONSOR'S ID NUMBER

LAL (..SN t

MI

'ART./SERVICE HOSPITAL OR MEDICAL FACILITY I RECORDS MAINTAINED AT

ENT'S IDENTIRCATION: For typed or mitten snots& give: Name • lest, first, middle* REGISTER NO WARD NO. ID No 0, SSN• Soy; Oats el HOW RenkrGraest


STANDARD FORM 509 (REV. EMSSEI Prescribed by GSA/ICMR FPMR (4ICFRI 101.11.20301(101

USAPA V1.00

9A MEDCOM - 981

DOD 004044

ACLU-RDI 1081 p.20

b)(6)-2

TIENT'S IDENTIFICATION: For typed or written amides. DAV: Nam, • lug. amt. "Wee; O No of SSN; Sax; DAM of 81/th; Rank /Grade,

REDISTI9111 WARD NO.


MEDICAL RECORD

_bprikelOM e 1 ft f7 15 t jefie_. ty Pg cum tr$5 etilf- Aim,. Riff novv-- 10_17 p in en. merk, Lbw clvriwAvisi" cu nakm )419A ft rex,- A •

iv 5-757), eiola, W26 . PT alp( cus rEle Nal itagp IP Ma/ WM t pAkpAs Pr , : iketns hi 3(e - c.ff— b)(eY2 --

visfidi ,- p-Iii /raw ve.Ltuirrt.w.41‘ / a'. Laccc < /t/eir.

tktiv Ccet4. 5 C tkuurui hot{ 44-6

YtittA top/9d • 411 redS c pat{ eevud 1\10# Chr n(

tiCT GU/Of COlt ?UV k mow/el

goo e far pr.? 5/( fh

p,pvte reffat-

j2071741

bX6)-2

DATE

PROGRESS NON

NOTES

ELATIONSHIP TO SPONSOR SPONSORS NAME SPONSOR'S ID NUMBER (SSN or Other) LAST FIRST

EPARTJSERVICE I HOSPITAL OR MEDICAL FACILITY re MAINTAINED AT


STANDARD FORM 609 Inv. 5/1229) livid by OSAIICMR FPMR MICFR) 10141.20MM

USAPA V100

7; MEDCOM - 982

,b)(6)-4

DOD 004045

ACLU-RDI 1081 p.21

;r 5. 3 -cAC),

—cae 04- 162- Gt...r,m-b7

b)(6)-2

5506--

1- f. . i

0 .3, LA0 6, lc( ...

I'd-a.-- r-r, _..s. ,.... r d-.,C-C se I 54v5

Lo r er r--e

r•--e

)(6)-2

Sr-c.4..L.0-r■

Cr

MIDDLE INITIAL- ID NUMBER LAST NAME FIRST NAME

DATE NOTES

iq Nog ec._e I Lre.c. - -k- ft c.ler-k. orceA— 03. 4,e.4- $--scil o

'ail- 04 r- CO r% C., e_ ."4 4_ ■-J-k4■A c o .,_,„‘Jl. q-ki- ....—

ca_e-i-ts-q.c) 4 5 c....7.-.), c.„.ht,- 6racre„..c.„- wc.).(9, 640.2. 1,,,,,til, i-eA 8 r.c-ik I, i 2_,S ka. '60c.c_ikr-' TPrIT e, I 2. S cciA r Li p.. i IV c c /4 -3- tkir clo_r-14-..

6e_e... - 6 o G-)f;k.e. v-r- k_-c,s..iTgo;-,,-s -a.-d— 110.0 1-1- -- 1.v

killiMMIAMMENW' WRY, _ ...._... 104'

a).0 Cr

CLI (ye% b)(6)-2

b)(6)-2

STANDARD FORM 509 IRKv. smaa) BACK NAPA VI OD 11)(6)-4

9g MEDCOM - 983

DOD 004046

ACLU-RDI 1081 p.22

;13)(6)-4

b) Detainee Classification: ❑ High Value Detainee

Security Detainee

TOC INFORMATION SUFFICIENT: YES ❑ NO ❑ FOR BCDFH STAFF USE ONLY

DEPARTMENT OF THE ARMY BAGHDAD CENTRAL DETENTION FACILITY HOSPITAL

APO AE 09342

Today's Date: ao t* a bok

Transfer Information Sheet

A. PURPOSE: To identify required information needed to facilitate patient transfer into the Baghdad Central Detention Facility Hospital (BCDFH).

B. GENERAL:

1. TOC/PAD

a) ISN number:

OR

Coalition Provision Authority Apprehension form completed with following information:

• Name of Detainee • Offense • Capturing unit's identification number • Capturing Unit's point of contact with DNVT phone number

AND • 2 sworn statements from the capturing unit.

2. MEDICAL INFORMATION:

• Date of Admission 10-001 .774 4'11

• Diagnosis: (13t4 keteAtelli eXP OP_ COCOrTOIUY

27 MEDCOM - 984

DOD 004047

ACLU-RDI 1081 p.23

SUBJECT: Transfer Information Sheet

• ttending Physicisn's name s d contact phone number/ or email: b)(2) 1

•••

3. NURSING INFORMATION:

• Patient mobility status: 04 Bed bound 0 Ambulatory

0 Paralysis: o Other:

• All routine and special treatments: wound, tracheostomy, or colostomy care, etc.) dcwiold Pao

edosit*,i ,

• Feeding needs: Diet IVPO

Tube feeding via: W) with

Assistance needed with meals? 10

• Bowel and bladder issue• Aim mmequ 0 •

• VisnaUhearing/speech impairment: "reit/6 Ligif •

9.R MEDCOM - 985

DOD 004048

ACLU-RDI 1081 p.24

HOSPITAL HUI/HT OF DEATH .."---1 NAME AND LOCATION OF HOSPITAL . haul arnaraaLza AlsAt OR we= Armoccovafersmolsomismou.

Inenicaans • &tied Oilier I atismista o Pmpare in one copy onty. limns I Mew, IO and sign Item I I. Print or typo amiss. Semi Aura math= eta* ta dui Nagai' rat 81Aarinfitttratire 015es• of the Day, for ogees:art

action and kr prejentien of mare 'Jumbo, of copies •

SECTION A - ATTENDING MEDICAL am- cars sugar PBSURAI. VATS

I. PATIENT DATA "admits aid ;erte nil kr axed w impkr idemifping des 17 avalab" ki i . 2. TIME OF DEATH or 4ffaaatapoa/ ..

.• ....) z 0 4 2. MELHCAL MANNER) CORONER'S CASE .

a 713 G. bx4)-4

•

ratleit's narna (Last. fast. middle iitiall Grade. • Sada, Security Accotast Na. Register Nude sod WO Number

4. Raman •••

E CHAPLAIN NOTIFIEDNOTIF

.. 111 23

6. NAME. ADDRESS AND RELATIONSHIP OF RELATIVE OR FRIEND PRESENT AT DEATH

•

CAUSE OF DEATH ' •

APPROXIMATE INTERVAL BETIVEZN [INSET .

AND DEATH

7. EIS= OR C011771011 ORTECTL, MOM To OFAINNakawsist ran them* .1 44 sit. ism Mlle aseasii sea li mouths deem 11#11;tramOatils Wilms., Mall,

DUE TO far es,' caosrmace 90 •

CO4kg 0 tx—e 4-4Ar-6-4 , '

.

7. LoTECEMOIT noes abotirormies.img Frdwfirstar./... rasa add, dr wleiVar sedisia Wit

MIETO Jams,' e mmosmarteero(l •

10 . G., -.. 14, .44 s • , 7 ,. ,,—.#4.7.- , E ....- -- 1,,,p-

•

123 . ...

3. ollffiR SUNIFIC.maT c CONTINDOTIOT SD TIE MM.

SI/TROT WATTS TO THE OR CONIIIIIII cupola TT

•

An.yrs S. 4ATE Ia. rim IN Ina/FREI ?MAE 4 810 GIME OF AlE0r-O. OFFICER RI ATTINOLOCE Il 13=4377111.0.001,./ KIWIS, 0(6)-2

Riles Aitly ',b)(6)-2

SECTION 3 - ADMIAISTHATIVE ACPASI V •

Trti Of ArnOtI I Nava I OAT' I 15OEN I DLR I n71.14T. OF REPORSIBLI WIWI

12. UMW TO NM OF ILI OR OMR AMMO= Mara . 4 I

12. FEST =OH= ofAIERAL aOTIRSI

14. MOUEDIATECO IN DECEASE 11111MEEO '

II

IS. 221139LIATIOM0RCE MEMO I ' I 1 I

Is -Farr MORTUARY OFFUTER MIMEO . . I I I

17. REO CV= 0010IED .

I I

18. OTREISmari I I I

s. I i • SECTION C . RECORD OF AIITOFST

:a. a010,s7PEAMAU•IL7pe *eau sad Wed •

0 T. Eii •

24 AUVOrst MEOW 8V S.Trusref

• • M. PROYMICIRAL Nauctoar.N RIM=

22.

:ATE I04. TIM auxE MO ac138 0;?toSiCilif PERFORMING AMITE I M. =ATM OF Ple1MCIA13 ?womn =MIT

i •

• i

i

5. 211E i 21 CEO maw An mot wra..—sraaa ;V. =TAME OF RECZT:u.s

1 I

. •

9Q MEDCOM - 986

DOD 004049

ACLU-RDI 1081 p.25

aclu-rdi 1081 p · 2019. 12. 12. · c. status.post small bowel resection and anastamosis with...

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