Part 86, page 51
Document date 19 July 1973
FBI 164-81, Vault Part 86 p. 51, Form, dated 19 Jul 1973 — cooper.theunsolved.net/parts/Cooper-Part-86/pages/51
Transcript
The scan is the source; the transcript is machine-generated from it.
COFFELT JACK P[atien]t #: 1743 19895
ADMISSION NURSES NOTES
TIME: 2:30 P.M. DATE: 7/19/78 PATIENT ADMITTED: WALKING________CHAIR________STRETCHER ✓ SERVICES OF DOCTOR:_________________________ VITAL SIGNS: TEMPERATURE 98² PULSE 100 RESPIRATION 22 HEIGHT______________WEIGHT______________BLOOD PRESSURE 12/90 ADMISSION DIAGNOSIS: trouble [guess: phlebitis] HISTORY OF: DIABETES__________ ✓E IF SO, WHEN?__________ HEART DISEASE_____ N IF SO, WHEN?__________ EPILEPSY__________ N IF SO, WHEN?__________ TUBERCULOSIS______ N IF SO, WHEN?__________ ALLERGIES: Mb1[guess: Xhoner], Seafood USUAL DIET: Regular MEDICATIONS PRESENTLY BEING TAKEN: Name Dosage Times a Day ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ MEDICATIONS SENT: HOME_________________ NURSING OFFICE_________ VALUABLES SENT: HOME__________________ HOSPITAL SAFE___________ LIST VALUABLES KEPT WITH PATIENT:_______________________________ DENTURES: YES ✓ NO_______ GLASSES: YES ✓ NO_________ URINATION: FREQUENCY normal NOCTURIA n.o TIMES PER NIGHT_____ BOWELS: CONSTIPATION? n.o LAXATIVES REQUIRED______________ CONDITION OF PATIENT (BRUISES, RASH, SKIN CONDITION AND/OR ANY OTHER PERTINENT INFORMATION): Pt is [guess: troubled/states] seems to be in a severe pain in the [guess: @] leg. [guess: Crying], and [guess: asking] something for pain.
[redacted] GD
NVD Form #04