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L�w <br />• ��nn r .. �j ::� Kl�1q �J <br />12Tve-A JV(en�Mia� -�lo=iaQ a.;i3 .i 7 T3 <br />' t <br />RECORD OF ADMISS <br />►af—lr.`i tY✓s{ ta'� See Note Be1�il�i��: - iVt `s...S. s•.••45i - i'.t <br />K, �,.:•o=:• •. •:: rt <br />when cques"Eicnea <br />t Ar• -•a.• <br />CIT., .• ..... ._. .:. w ata - <br />t.. t !i:•f.::r <br />• <br />' Doe, _John <br />�t :.Ci i\ .. •tilt' L •� .•a•1 � i • <br />r.. •• <br />• <br />�;; ,:.. - , .�� = ' <br />4.� �. —TV, .. • .... • <br />;;;;;rias t 12-803 <br />.. .. ••JJI \JWi • i{• .. • <br />name is i ohhHy <br />r•;tlf ty---re-)• <br />�•: c�-�O4•.• ,-.= } <br />No positive Info <br />on this <br />R.v c►'! tt.c.w ha t <br />A.,t ,ir!ri X0}414 <br />1% / 6 1: 00c'3JI1 <br />tN; CO7ctVr e:.:viSS :4 <br />MALE <br />2 t(q•AlE <br />r ••4 :JD! YtVG M : <br />. '• e 4 1 1 <br />+ •if<K salt l <br />CR: M/T/G <br />•^a+t:I 1•44 V4 <br />11/05/8 SU <br />: <br />CCU <br />QM; <br />323 <br />•O.b..:Ct7til <br />xsol. <br />- <br />P-34200, ' <br />LS•:.RA4 t!S( <br />• <br />!4051 !w!ct'i! .�.• 'C' <br />ztltt . StAIE • 1P t: <br />(yya.:.r'O: r••.%t <br />• <br />•. <br />YES NO <br />•j.4Yti! 3- i' .r R•t"39 <br />- .. <br />`• • . : ` :4 .,' «± <br />t� • = A• •• ' �• •- _ _ - <br />a s• .1 4'• <br />�...4: t.ro.O•4a <br />!•:1.is.tR %•.:r�tSi :a±. •v i:.1t f :.r <br />_s±:•.. ... <br />'tatit.O+ta %J <br />t <br />ro sstE1.0-waa <br />• r:ro;v+ti g.^:wa!}a 'a1Rlt' .'• Staa t <br />'J!tXCARE Mce, NU'ABER <br />PART vts %0 t:E_•:::•+Q •Q. NUMBER <br />:oavaa•Jv r.r App <br />41RtQ. <br />B I + <br />:NFO.Ell <br />K, �,.:•o=:• •. •:: rt <br />when cques"Eicnea <br />Dy '• s—u•* <br />sZaTes T1c.Ll:\e 15 <br />Ut: Bally• 4.ciL 1l Vil <br />:-•:�-_• = .=_. <br />Sheriff Office states his <br />name is i ohhHy <br />r•;tlf ty---re-)• <br />�•: c�-�O4•.• ,-.= } <br />No positive Info <br />on this <br />of at Admission <br />-- <br />Time:.-, %c y <br />tN; CO7ctVr e:.:viSS :4 <br />— <br />SUB. NA:•E <br />tx FS CERT•F.CAl NO <br />C-40up <br />. t <br />a <br />'a•t <br />SUB. NAVE <br />PDOVISPONat 01=-�,NQS157 <br />FINAL D:AGNOSIS: <br />_5/c <br />4 <br />0. <br />F%-xLt'/'cd V, 4cr, e, e, t ei <br />SECONDARY DIAGNOSIS OR COMPLICATIONS: •._• <br />o <br />:$i <br />OPERA' 1( N:. •'•- 1.� � �c C-r>t G HP Dote tine <br />DS <br />3- �,,,��t�.-. fit �w•.«-� � •.?tt.� �-; OP <br />• CON <br />;04SWAVON *01114 SPONSOR <br />C!tit! O1 b{Atw Autopsy •ES •+ <br />ter <br />••••+1 Ica`a•h!. t.►• t•tC•.o\ rt. r.• ��ti —� tG'WD r. a•'f•.. •:. f.... a� .��. <br />.. maw.y..«e»:+t......�.•-•.,.,..�...,v ,... ,.. � Pr—+. n •--», <br />.. .1. _ "Tit.•avi^r+:',f:c'�:.•sA4.e�C�'�•M,m�••..'.^;o:�Y!M.'T^. ^�+•;.�F`.+e.W.'.ft!GRT••KY.r I�Y•!"•P�1�M.at.N4�.4.cvv�_. <br />JUL 0'5 1973 <br />ra <br />LLs,_ 275 <br />