RADIOGRAPHIC REPORTS - CARANCI, JOHN C.
Document Type:
Keywords:
Collection:
Document Number (FOIA) /ESDN (CREST):
0001415105
Release Decision:
RIPPUB
Original Classification:
U
Document Page Count:
1
Document Creation Date:
June 22, 2015
Document Release Date:
December 31, 2008
Sequence Number:
Case Number:
F-2007-00327
Publication Date:
January 17, 1968
File:
Attachment | Size |
---|---|
DOC_0001415105.pdf | 76.01 KB |
Body:
Scandard Form 519
Rev. August 1054
Bure3u of the
Bu ?,Cec Circular A-32
CLINICAL RECORD
APPROVED FOR
RELEASE DATE:
1O-Nov-2008
U.S. GOVERNMENT PRINTING OF`ICE 10,4 0-715-468
RADIOGRAPHIC REPORTS
ATTACH 30 REPORT ALONG HERE /k AND UCCEEDING ONES ON ABOVE LINES
i'i ~++,~??1La ,..11: -LC
11 Ia. GAGE ; INTACT
A i '`.~tr>~'.. Ct''
OATS CF ECUEST
SIGNATURE: !(Soecif}/Ioolion pf lobpr tory if not port of raques'L^.g c ":y
PATIENT'S (OENTIFICATION' (For typed or written entrietgiuer Name-last, first, middle;
' PATIENT'S LAST NAME - FIRST NAME- MIDDLE NAME
REGISTER No.
(Check one)
(Above spo 0 fir moclocnzyLun}orir ii 4 e)
PERTINENT CWw {I jk- RATIONS, PHYSICAL FINDINGS; AND PROVISIONALbIAGNOSIS .
RADlUDRAPF?IC REPORTS
Standard Fo?m, 519
519-16
(bl61
(b131