NVDH medical history intake form for Jack Coffelt
Document date 7 July 1973
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Id: Cooper-Part-86:041-041
Subject: Cooper Files: Cooper-Part-86:041-041 Document: NVDH medical history intake form for Jack Coffelt Id: Cooper-Part-86:041-041 Page: https://cooper.theunsolved.net/documents/Cooper-Part-86%3A041-041 What is wrong (title, date, type, which pages belong together, copies)? What does the scan show?
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FBI 164-81, Vault Part 86 p. 41, Form, dated 7 Jul 1973 — cooper.theunsolved.net/documents/Cooper-Part-86%3A041-041
NORTHERN VIRGINIA DOCTORS HOSPITAL HISTORY
COFFELT JACK 7 [?] 79895
INFORMANT [REDACTED] DATE 7/7/73
CHIEF COMPLAINT: "I have pain in my L leg"
PRESENT ILLNESS: This is [the] first NVDH admission for this 48 y.o. W.M. former employee who complains of acute self-[guess: treatment] in L leg. He has had [guess: soreness/min.] for 3-4 yrs BTA and was once hospitalized for 1 wk. for edema 2° to [guess: thine] varicosities. 4-5 days BTA pt [guess: moved] lifted heavy object and felt burning sensation in lower medial L leg - a local swelling developed at this time (this became tender, exquisitely so at 10 A.M. today 7/6/73 when pt stood and noticed hot, flaming [guess: sensation] this very localized region below the knee. 11 [guess: hrs], this sensitive to standing, less [guess: under] [guess: this time]. [guess: Erosion] [?] hurt to walk but is very [guess: susceptible] to [guess: edematous] [guess: signs/standing]. [guess: Mentions] no muscle cramps
PAST MEDICAL ILLNESS: Allergies - 0. Surgery - 3x for inguinal hernia. R ear, nasal bone replaced - 3 yrs. BTA. Food general health otherwise.
FAMILY HISTORY: NC - orphan.
SOCIAL HISTORY: Smoking Hx - 1-2 packs/day x 30 yrs. ETOH - heavy - calls self "borderline alcoholic".
REVIEW OF SYSTEMS: N.C.
Signed [REDACTED]
N.V.D.H. Form No. 23 REV 4 66
Serials: 79895