DOD 003674

3 c oP

FOR OFFICIAL USE ONLY

PROGRESS NOTES Medical Record STANDARD FORM 509 (REV. 511999

Prescribed by GSNICAIR MINI (41CFR) I01-11293(13)(10

EXHIBIT

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MEDICAL RECORD

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RELATIONSHIP TO SPONSOR SPONSOR'S NAME

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PATIENTS IDENTIFICATION: (For typed or wriUen entries, gA,: Monts - last, first rnirklie; ID No or SSN; Sax; Date of Birth; Raraagrade)

ECOROS: I

REGISTER NO.

PROGRESS

DEPARTISERVICE

ACLU-RDI 1052 p.1

SYMPTOMS, DIAGNOSIS, TREATMENT, IAEA

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AL RECORD

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PATIENT'S IDENTIFICATION: (For typed or wtten entries, give: Name • lost, fest rreddis; to No or 35N. Sex: I

Oato of Oink FlorridriGraded

(WARD NO .

co,44409, ,

0.0441/,

etP X.-1'14464-AP" e 7 5 .564.'‘-470-

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FOR OFFICIAL USE ONLY

CHRONOLOGICAL RECORD OF MEDICAL CARE *Weal Record

FORM 600 IRO/. 6-97)

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MEDCOM - 613

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DOD 003677

UU ‘; 5 MEDCOM - 614

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AlN0 ISP TVIDIMO

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(b)(6)-4

MUEWCATIONS:

:44

d Co , BID prn Sena l25- qhs p( SL NTC 0.4 nigiwn x3 (chest pain)

DIAGNOSTIC TESTS: PMILX:

GUIAC STOOL- Sept. 2003, negative

PEAK FLOW-

EKG- June 2003

PSA-

OTHER-

MI x2 hypercholesterolemia hypertension Hemmoriod surgery (1995) smoker hemmoriods

HOSPITALIZATION SUMMARIES:

FOR-OFFICIAL_ USE ONLY

EXHIBIT

uv6. MEDCOM - 616

DOD 003679

ACLU-RDI 1052 p.6

rX,S0 - Coq-- C—■ - SE"

AUTHORED FOR LOCAL REPRODUCTION

CHRONOLOGICAL RECORD OF MEDICAL CARE

SYMPTOMS, DIAGNOSIS, TREATMENT, TREATING ORGANIZATION (Sign each entry)

1\3 e Stir,r\\..5

PREVIOUS EDITION IS USABLE

MEDICAL RECORD

DATE

Witt_re-

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IT) rONLY

(b)(6)-4 CHRONOLOGICAL RECORD OF MEDICAL CARE

Medical Record

STANDARD FORM 600 (REV. 6-971

OFR PresClibecl by GSMCMR F(RMR 141 CFR) 20

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PATIENT'S IDENTIFICATION: (For typedath;

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Uvi_ MEDCOM - 617

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CERTIFICATE of DEATH (OVERSEAS., Acte de deco (D'Ourre•41er)

cieer 1a C

FO R M 2064 REPLACES AF FO DO 1 77

ICH IS OBSOLETE.

MEDCOM - 618

Cr-k- - CAS1-7-cq -

NAME OF DECEASED 'Wal Fin, nada") Nan, du decide (Num II n4enres1 GRADE Gisela BRANCH Of Si... ,Of:':. Arms

SOCtAL SECuRi7 -, r.A.w.e.e..,

ID)(6)4

ORGANIZATION Organisation NATION Ices Undid Slafet1

Pay,

A CL. 1

DATE OF BIRTH Dalt or nsmance

SEX Soso

RMALE Miecul,

n, F EMALE F.jeran,n

RACE Rees MARITAL STATUS Elm Civii RELIGION Cull.

CAUCASOID Cautwloue SINGLE Cillbaralm OIVORCE 0

DIvorci

PROTESTANT Protestant

OTHER (Specify) Au.,. (Spicifeer I

NEGROID Wertild•

CATHOLIC C•tholiqua MARRIED Mani

SEPARATED Sipare OTHER (Spiteltyl

Auto.* ISpicIfie") WIDOWED \su, JEWISH _Wit

NAME OF NEXT OF KIN Nom du plus proof. parent RELATIONSHIP TO DECEASED P ...ea do dicicla &vac la su alt

STREET ADDRESS DomicIli; liquid CITY OR TOWN AND STA TE !Include ZIP Code; Villa [Coda paws! comoisl

MEDICAL STATEMENT Ddiclaration anidicala

CAUSE OP DEATH (Ent, only one cause per Une,

Castle do diois IN'Indlquar ou'un• cause par licoel

INTERVAL BETWEEN ONSET AND DEATH

Imarvalle antra l'arteque at la dads

DISEASE OR CONDITION DIRECTLY LEADING TO DEATH'

Maladie ou condition Mom Simians resoonsable do l• mart'

attA__..b..-., M T capc(2,(c4 (...A.4._ kc..+1.- 4,4,,,,

ANTECEDENT CAUSES

Sympearnes or:curlew. de la mart

MORBID CONDITION, IF ANY, LEADING TO PRIMARY CAUSE

Condition mord. VII y 6 1111,

manant i la cause primp,.

00 CO-1\\ -.-- (VI- '\. 4 '1)-(A_c 0-A--Cc _ --

'...._

UNDERLYING CAUSE, IF ANY. GIVING RISE TO PRIMARY CAUSE Ralson Iandernentelo, III y a lie..

avant sunk.; IS Cos" prIm•Ira

OTHER SIGNIFICANT CONDITIONS!

AlMee COncIllioril ellinIfIce 11...2

MODE OF DEATH AUTOPSY PERFORMED AutOpili• ellactuee ❑ YES Om 0 NO Non

CIRCUMSTANCES SURROUNDING DEATH DUE TO EXTERNAL CAUSES Circonstances de la mart auscitoos oar am causes ..rigor.

Cisii13,:lb a u■AciN\ c(_k. c.... \ i

CLWA-±

Condtion Oa dies MAJOR FINDINGS OF AUTOPSY Conclusions onnaioatas do ...I..

NATURAL

Mart naturally

ACCIDENT

Mart accidenoslle

SUICIDE

Suicide

NAME OF PATHOLOGIST Nom du pathalogIste

HOMICIDE

HornIcida

SIGNATURE Signature DATE Data AVIATION ACCIDENT Accident a Avian

0 YES Om ❑ NO Non

DATE .. daOreclEs ABZUHre*. '1;.;Not:', re °mnot. Yl!o0n1n1 e. I

PLACE OF DEATH Lieu de Micas

I HAVE VIEWED THE REMAINS OF THE DECEASED AND DEATH OCCURRED AT THE TIME INDICATED AND FROM THE CAUSES AS STATED ABOVE.

. fa , ....Ma Ie. runs mortals du Cato ,. at II canclus que to acin III survanu I I'lleure inclicedie at V. i• wile des causal linumir‘et [i.e...

(b)(6)-2 TITLE OR DEGREE Tlir. au dl MI

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'cot- , NS ou acIrma• c.D

B( pc DATE Dm

og pa ✓ -I b)(6)-2 LICoL. USAF. MC , SFS

1b)(6)-2 I 'State disease. injury or compile tion i 2SCate conditions contributing 10 the d

IC .

SHAW AFB. Sc . la maniire de mourir Celle u on acre; d coeur. etc.

I ?Weiser la nature de la maladie. de L. non

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DOD 003681

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C) • C> 0-2--"(;) ca,C>

ARMED FORCES INSTITUTE OF PATHOLOGY Office of the Armed Forces Medical Examiner

1413 Research Blvd., Bldg. 102 Rockville, MD 20850

1-800-944-7912

PRELIMINARY AUTOPSY EXAMINATION REPORT

Name: :b)(6)-4

SSAN: Date of Birth: 6 DEC 1948 Date of Incident: 8 MAR 2004 Date of Autopsy: 10 MAR 2004 Date of Report: 11 MAR 2004

Autopsy No.: ME04-110 AFIP No.: Pending Rank: EPOW Place of Death: Baghdad, Iraq Place of Autopsy: Baghdad

International Airport

Circumstances of Death: Circumstances of Death: This 55-year-old male Enemy Prisoner of War had a history of ischemic heart disease. His past medical history includes hypertension, hypercholesterolemia, and possibly two previous myocardial infarctions. His medications included atenolol, Zocar, and aspirin, as well as sublingual nitroglycerin as needed. On the evening of 7 MAR 2004 he complained of chest pain and shortness of breath. He was brought to the medical clinic for evaluation where he became unresponsive. Resuscitation efforts, including Advanced Cardiac Life Support at a medical treatment facility, were unsuccessful.

Authorization for Autopsy: Armed Forces Medical Examiner, per 10 U.S. Code 1471

Identification: Identification is obtained by paperwork accompanying the body,

including a photograph with a matching prisoner number.

CAUSE OF DEATH: Atherosclerotic Cardiovascular Disease

MANNER OF DEATH: Natural

FOR OFFICIAL EO TY

These findings are preliminary, and subject to modification pending further investigation

and laboratory testing.

MEDCOM - 619

EXHIBIT ■

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t)C)`"C) C--\ 02-'-f=3 -

2 1(b) (6)-4

ME04-110

PRELIMINARY AUTOPSY DIAGNOSES:

1. Atherosclerotic Cardiovascular Disease

A. History of ischemic heart disease B. Cardiomegaly, marked (heart weight 620 grams) C. Coronary atherosclerosis, focally severe D. Diffuse myocardial scarring E. Arterionephrosclerosis, mild

H. Marked Pulmonary Edema

III. Remote penetrating ballistic injury of the left buttock A. Entrance: Inferior-medial aspect of left buttock (scar) B. Wound Path: Skin, subcutaneous tissue, and muscle of left

buttock, muscle of proximal left thigh C. Recovered: Metallic foreign body encapsulated in fibrous tissue

within muscle of proximal left thigh D. Wound Direction: Left to right, back to front, and downward

IV. Fractures of the 5 th and 6 th ribs on the right, associated with hemorrhage into chest wall musculature and abrasions/thermal injury of the chest (resuscitation efforts)

V. Laceration of the nose and abrasion of the right index finger

VL Toxicology Pending

;b)(6)-2

MD, FS, DMO CDR, MC, USN Chief Deputy Medical Examiner

FOR OFFICIAL

^fBIT 15

USE ONLY

MEDCOM - 620

DOD 003683

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