FormNVDH radiology requisition for chest and right shoulder X-rays, Jack Coffelt10 July 19721 page
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Part 86, page 36

Document date 10 July 1972

Open in FBI Vault (Part 86, page 36 of the PDF)

FBI 164-81, Vault Part 86 p. 36, Form, dated 10 Jul 1972 — cooper.theunsolved.net/parts/Cooper-Part-86/pages/36

Transcript

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Coffel, Jack Employee NVDH

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NORTHERN VIRGINIA DOCTORS HOSPITAL DEPARTMENT OF RADIOLOGY

REQUISITION FOR ROENTGEN EXAMINATION b6 b7C Insurance: GHI ☐ No GHI ☐ (Check one) Transport to X-ray department by ☑ walk ☐ chair ☐ stretcher. (Check one) Part to be examined: (D) Chest (3) Rt. Shoulder

Clinical Diagnosis: trauma - due to accident at work

Nurses Signature b6 b7C

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Report of Roentgenologist

Date of Examination___________ X-Ray No. 66674

Roentgen Findings

July 10, 1972

RE: Jack Coffelt, # 66674

Dear [REDACTED]

X-ray examination of the chest reveals the previously described blunting of the left costophrenic angle secondary to scarring. Old healed rib fractures are noted on the right. The lung fields are clear. The heart is unremarkable. The aorta is elongated calcified at the knob and tortuous. The lateral view reveals degenerative changes of the thoracic spine.

X-ray examination of the right shoulder girdle reveals no evidence of fracture or subluxation. Minimal degenerative changes are noted.

N. B.—The Radiologist will be pleased to confer with the Attending Physician with respect to all cases referred to this department.