*
,
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