Part 86, page 62
Document date 13 December 1971
FBI 164-81, Vault Part 86 p. 62 (DB Cooper-37906), Form, dated 13 Dec 1971 — cooper.theunsolved.net/parts/Cooper-Part-86/pages/62
Transcript
The scan is the source; the transcript is machine-generated from it.
COFFELT, JACK EMP.
NORTHERN VIRGINIA DOCTOR'S HOSPITAL DEPARTMENT OF PATHOLOGY SEROLOGY I
DATE: 12-13-71
☐ Direct Coombs ☐ Indirect Coombs ☑ Admission Serology mn [guess: reactive] ☐ Rh Titer ☐ Pre Marital Serology ☐ Monospot VDRL Slide Test ☐ Heterophile ☐ VDRL Quantitative ☐ ASO-Titer ☐ FTA - ABS ☐ R. A. Test (Latex) ☐ Febrile Agglutinations ☐ C-Reactive Protein
[Handwritten notation at bottom right]: 5.12.7 [guess: K]
---
COFFELT, JACK EMP.
NORTHERN VIRGINIA DOCTORS HOSPITAL DEPARTMENT OF PATH[OLOGY] URINALYSIS
DATE: 12-13-71
SPECIMEN TAKEN BY ☐ Cath [guess: Avoid] Clean ☐ Catch ☐ ADMISSION URINALYSIS ☐ Repeat Urinalysis Appearance ________ Reaction ________ Specific Gravity ________ ☑ Albumin ☑ Sugar ☐ Acetone ________ ☐ Diacetic Acid ________ ☐ Bilirubin ________ ☐ Urobilinogen ________
Leukocytes ________ Erythrocytes ________ Casts: Hyaline ________ Finely Granular ________ Coarsely Granular ________ Cellular ________ Waxy ________ Epithelium ________ Crystals ________ Mucus ________ Miscel: ________ ☐ Occult Blood ________ ☐ Glitter Cell ________
☐ Bence Jones ________ Protein ☐ Sulkowitch ________ (urinary calcium) ☐ Porphobilinogen ________ ☐ Phenylpyruvic ________ Acid ☐ Serotonin (5HIAA)
24 HOUR SPECIMENS: ☐ VMA ________ ☐ 17 Ketosteroids ________ ☐ Catecholamines ________ ☐ 17 Ketogenicsteroids ________
TECH [stamp/initials] DATE Nurses Signature 12-13-71
---
CHART
DB Cooper-37906