Indiana University School of Medicine - Caduceus Yearbook (Indianapolis, IN)

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Mb40JZU0 I IINUIAIMA UlMIVfcnoI 1 T MUorl 1 ALo HISTORY YSICAL-PROGRESS-OTHER «CIRCLE ONE) Medical Class of 1973 Indiana University Medical Center 1100 West Michigan Indianapolis, Indiana Dote Patted: PasPi 'jll P,lta-K.t (A % 2 ' qp li. - pZA . Y yZZ taZALJ j ZOz SO W y z: d y Zx LaA skSa f ZdZ d M Z Z y A' 7-S ?Z- ??U Ldy. -? . 7b .A?y c -ru Zy? r yy A SAZ Z sZZfcz ' i 0 d Sd-c aA Z l T-t a ! 7 d y d) .Ay ■ ? 7 .ypy) dAtd i jr 71 A: A- z jicx. - -yL . yA Z Adt did flA'-U lTa r AS.' Zts 7 tUX 't'L Z au tlAZt. ) , A e ) aZ , 7 W Z-t Z. jL A lZ d 7x X. 7)4 Ad . .7 AAWyx 7 yrZ Ald sd ? ’) A £ Jsn j. a Ls J % d-d dZL j. Ad? 7s Zyr , X' L L7)1 dAiTL tZj 0 4ZA4J Zd y . AZA Zd yd yizf’ Z7 ' d Z ZZ J 4 d yZ tZ si' ?Zyd-y C sC4S. Z Z 'S -1p£ 'ru1s zz. A To a . P c 7 j-tXA adsrp T d ddjs {J 'i ‘Jia.ii(x LL.-iAjjL 4AAj£tjj. ASTT yA z sn 7 7 7 Z?'' CLin LAdt Q£ Zj clYlS pll r pACu 7 ) ZZ A a - TUt-AJa loAxIac -nJL Z-cz j ) A s. y 77 z - Z Z -z rn Z j A (A (A c Aztjr LyJfrs. A AZi jA c y ZZ ZZTfZ A srt A S ( L-A tl')rJ X L l 7 Z iA )Z nxd n Z ZZ Z ) , ' C' - T Aa pLftZiZ ASl la7 7 zl A'-C i'lA dxn dAJ ft fat+-7Z A Ldsi K n 7 uZl ZA-P A Z dtdzA it? ? -tS7■? ) zZ Z S 7zf ? 'M 'Ja S t 71'l C lZTTtAT S Zu 71 Z Cj. X Z oZZ fiy l UdKL 7Zy A ZZZ dL Z JAyyjLdn A n f 7 S. Csni..JjL JJ £rLtLt) tA( pA-tb-Att U) ,ilf - JtA-dpy C 1 fV A Z Jdi'i'iA' A y vZ L 7 L Z - ZL7J7 ZZ a-X- Z lZ-JaJC A„ 7)Zy a jL Z iZZ4 v ?i ; U Z A t ZLd. S d Jjy t Ss' '-nx 7-dl l'dn Z X 7hl LJJ y stdA -Zu n . J Zf A . ') l nZ 7 0 Za Z J 71 d i : ) cZ iZx n nfijZ.wa Syt 7 A 5 Z . ?v7 7yt A{-nn ° Z , ) Z mi S Sj Z lZO . ST Zdl. c Z JL ZdL : p -r A r ,ZfcJ y yiAl Z . y z S Jy C CC C . j-dXi j c-o-ti' Lo t z d-r.sxJP' -a.'i'i ' tA . .f . USE ONE SIDE ONLY ■ f HISTORY-PHYSICAL-PROGRESS-OTHER. ID (CIRCLE ONE) 1 ■ ■

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MEDICAL tECOED PATIENT’S PROBLEM LIST IMPOtTAgJ - DO NOT USE ABBREVIATIONS. This form may be used for inpatient patient-members and outpatients. Upon DISCHARGE, place farm ia the Medical Record folder (Type U) beneath the VA Form 10-1000 or 10-1000a. Upon READMISSION, amove form and place with caneat records on ward. PROBLEM NUMBER APPROX. OATS OP OMSCT ACTIVE PROBLEMS DATE PROBLEM RECOROEO INACTIVE RESOLVED PROBLEMS DATE RESOLVED ? Afevro anaitoy f fitfhtMidrvf lj Mato ow 3 rifo bay r M na 04 1 V HicrdfrclMy tfdrain )Jwy PhtflJo aq 6 Of jtha urf ajffd f fiant 7 1 ifer ia rfed vii 5uraer 1 U r OB-6i yd 10 ec tain't-s deun oa y Psj cJua trS % Ad M ! s AraA os? •e Safer; PA Sf u'or £ echuejfd!Am? TIEMT IOEMTIPICATIOM - TREATINO FACILITY - WARD MO. - DATE Nodical Class of 1973 Indiana University Medical Csntsr 1100 Vsst Michigan Indianapolis, Indiana mimcal atco to PATIENTS PROBLEM LIST TaVSS 10-1415 •04IS2

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