* , noo t eee woe - me 2 ~ ' Oar. . A oS goi’ eT aa ~ . 6 ~ tow we YS... a me . CBS: . a a. ye iT P tm eo. \ on . A a all continuations ef a particular Wem) a4. ApbITiomaL Ramangs (Show Uem ssamber to whick, extended entry applies. os ee wero me. - ee yo. 7 } ‘. -. we . x 2. ov ane AY rm ~ a SlCK INSTRUCTIONS FOR ITEM 23: Enter primary cause of admission first, followed by additional diagnoses present in order of importanee; then by later diagnoses in chronological order preceded by dates made. Number diagnosis in order. Record For fully—including causative agent, how, when, where, doing what, for injuries—in accordance with separate directives. “PR” (pre“P all diagnoses established by pathologieal findings, so state. Each chronic condition must be indicated-as either viously reeorded) or “Not PR.” Similarly, any other comdition which has been recorded in a previous admission will be so indicated, showing the previous diagnosis. place, date, and register In all cases designated as previously recorded, show number of previous admission. Every condition that existed prior to service will be indicated as “EPTS.” Diagnoses of venerea! disease and malaria will be characterized either as “EPTS” or as “‘Not EPTS.” In the case of diagnosis from For each which recovery eccurs prior to disposition of the case, a date will be shown, thus: “Recovered, 11 May 1951.” diagnosis line of duty Misconduct,” “‘LD, status must be shown in accordance with separate directives, thus: ‘LD, No, EPTS,” “LD, No, Yes, EPTS, Aggrevated by Service,” etc. “a * 38. CAUSE OF DEATH TMIS DOES NOT MBEAN THE BORE OF BYINGE, BOCR AS MEART FAILORE, ABSTHESA, ETc. IT BEARS la. tat DISEASE, INJURY, or COMPLICATIONS WRICM CAUSES DISEASE DEATH OR CONDITION DIRECTLY LEADING DEATH b. pus to (Or as the consequence of} WORBID CONDITIONS. IF ANT. GIVING, RISE TO THE ABOVE Cawse (item Ia) sTaTING THE UNDER: 4 ¢ pug to (Or as the consequence of) THIS MEANS CONDITIONS CONTRIBUTING TO THE DEATM BUT NOT RELATED TO THE DISEASE ORF CONDITIONS CADSING DEATH. Tl, {De net enter TO | | INTERVAL BETWEEN ONSET | | | mere than one cause per line ANTECEDENT CAUEES fer iserns Ia. b, and c) — } . LYING CAUSE LAST. OTHER SIGRHMCANT CONDITIONS | i. as | 36 _ AUTOPSY PERFORMED (if ‘Yes" indicate dace amd place} 37. HOUR AND DATE OF BEATH 39 SIGMATORZ OF PITYSICIAM 4 Lok, Be. ERACT PLACE @F DEATH 3 se . ~ na a 7 so r _ MECUEDL COng POM eRe Le eRe NIE (802. ae ‘ cere ~ . AND DEATH