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Medical Records of U.S.

Casualties of Iraqs Chemical Weapons


22 Pages - Contributed by NYT News, The New York Times - Oct 13, 2014
BEASLEY BLISTER PROGRESSION**PHIPPS CLINIC
DAYl DAY 3 DAYS
I~~~
DAY 7 DAY 7 DAY 8After Debridement
BEASLEY BLISTER PROGRESSION**PHIPPS CLINIC
DAY 3 DAYS DAY 7
~'I"""'Ii':' r" <r
.'fl h[Ur-H1
DAY 9 DAY 9 DAY 10/ After Debridement
SPC RICHARD BEASLEY
PIDPPS CLINIC, BALAD, IRAQ, LSA ANACONDA
12MARCH2007
BLISTER EXPOSURE FROM LIFTING ORDINANCE INTO
VEHICLE
HEALTH RECORD
CHRONOLOGICAL RECORD OF MEDICAL CARE
Patient: BEASLEY, RICHARDT
Facility: WX63AA
Date: 15May 20071455 AST
Clinic: 206ASMC (ANACONDA)
Appt Type: ROUTN
Provider:
AutoCites Refreshed by @ 15May2007 1534AST
Problems
INJ URY DUE TO WAR OPERATIONS BY GASES, FUMES, AND CHEMICALS
CONTACT DERMATITIS DUE TO CHEMICAL PRODUCTS
visit for: follow-upexam
INJ URY FROMTERRORIST EXPLOSION BLAST
violent traumatic event a terrorist attack
Active Medications
Medication Name Status
SILVER SULFADIA (SILVADENE)--TOP 1% Active
CREA
CLiNDAMYCIN--PO 300MG CAP Active
HYDROCODONE/BITARTRATEl ACETAMINOPH Active
EN - 5/500MG
MORPHINE 10MG/ML CARPUJ ET Active
SILVER SULFADIA (SILVADENE)--TOP 1% Active
CREA
SILVER SULFADIA (SILVADENE)--TOP 1% Active
CREA
CLiNDAMYCIN--PO 300MG CAP Active
SILVER SULFADIA (SILVADENE)--TOP 1% Active
CREA
CLiNDAMYCIN--PO 300MG CAP Active
SILVER SULFADIA (SILVADENE)--TOP 1% Active
CREA
HYDROCODONE/BITARTRATEl ACETAMINOPH Active
EN - 5/500MG
Allergies
Patient has no knownallergies
Screening Written by @ 15May20071455 AST
Sig Refills Last Filled
Q DAY WITH BANDAGE CHANGE 15Mar2007
TIDX 20 DAYS 15Mar2007
2 PO 30 MINS PRIOR TO FOLLOW-UP J 6 Mar 2007
10MG 1M 20 Mar2007
WITH DRESSING CHANGE 28 Mar2007
APPLY WITH DRESSING CHANGE 30 Mar2007
TID 01Apr 2007 .
APPLY WITH BANDAGE CHANGE 12Apr 2007
2 PILLS BID 13Apr 2007
WITH BANDAGE CHANGE 13Apr 2007
1Q 4-6 HRS FOR BREAKTHROUGH 13Apr 2007
PAIN
Appointment Reason For Visit: Administrative Evaluation Services; _
Selected Reason(s) For Visit: _
Administrative Evaluation Services (New) Comments: LODfor Terrorist Attack I Chemical Exposure
FMP/SSN:
DOB:
peat: All USA AD
MC Status:
Insurance: No
Sex:
Tel H:
Tc1W:
CS:
WS:
M
Name:BEASLEY, RICHARD T
Sponsor:
Rank:
Unit:
Outpt Rec. Rm:
PCM:
TeL PCM:
BEASLEY, RICHARD T
SPEClALIST 4 E4-A
WB60AA
STANDARD FORM 600(REV. 5)
Prescribed by GSA and ICMR
FIRMR
nus INFORMATION IS PROTECTED BY THE PRN ACY ACT OF 1974 (PL-93-579). UNAUTHORIZED ACCESS
TO THIS INFORMATION IS A VIOLA TrON OF FEDERAL LAW. VIOLATORS WILL BE PROSECUTED.
CHRONOLOGICAL RECORD OF MEDICAL CARE
Page 1of 1
HEALTH RECORD
CHRONOLOGICAL RECORD OF MEDICAL CARE
Patient: BEASLEY, RICHARD T
Facility: WX63AA
Date: 02 Apr 20071438 CST
Clinic: 206 ASMC (ANACONDA)
Appt Type: ROUTN
Provider:
AutoCites Refreshed by @ 02 Apr 2007 2025 CST
Problems
INJ URY DUE TO WAR OPERATIONS BY GASES, FUMES, AND CHEMICALS
CONTACT DERMATITIS DUE TO CHEMICAL PRODUCTS
visit for: follow-up exam
Active Medications
Medication Name Status
SILVER SULFADIA (SILVADENE)--TOP 1% Active
CREA
CLiNDAMYCIN--PO 300MG CAP Active
HYDROCODONE/BITARTRA TE/ACETAMINOPH Active
EN - 5/500MG
MORPHINE 10MG/ML CARPUJ ET Active
SILVER SULFADIA (SILVADENE)--TOP 1% Active
CREA
SILVER SULFADIA (SILVADENE)--TOP 1% Active
CREA
CLiNDAMYCIN--PO 300MG CAP Active
Sig Refills Last Filled
QDAY WITH BANDAGE CHANGE 15 Mar 2007
TID X 20 DAYS 15 Mar 2007
2 PO 30 MINS PRIOR TO FOLLOW-UP 16 Mar 2007
10 MG 1M 20 Mar 2007
WITH DRESSING CHANGE 28 Mar 2007
APPLY WITH DRESSING CHANGE 30 Mar 2007
TID 01 Apr 2007
Allergies
Patient has no known allergies
Screening Written by @ 02 Apr 2007 1438 CST
Appointment Reason For Visit: CONTACT DERMATITIS DUE TO CHEMICAL PRODUCTS; _
Selected Reason's) For Visit: _
CONTACT DERMATITIS DUE TO CHEMICAL PRODUCTS (Follow-Up) Comments:
Vitals
Vitals Written by @ 02 Apr 20071438 CST
Pain Scale: 3/10 Mild
Comments: no vitals needed
SO Note Written by @02 Apr 2007 1459 CST
History of present illness
The Patient is a 22 year old male.
o Encounter Background Information:.
Subjective
Pt is here for flu for exposure to a blister agent - mustard gas.
Physical findings
General appearance:
General appearance:. 0 Patient was awake. 0 Patient was alert. 0 Patient was oriented to time, place, and person. 0 Patient
appeared well developed. 0 Patient appeared well nourished. 0 Patient appeared well hydrated. 0 Patient appeared healthy.
o Patient appeared active. 0 Patient appeared to be in no acute distress. 0 Patient did not appear chronically ill. 0 Patient did not
appear acutely ill. 0 Patient did not appear poorly hydrated, 0 Patient did not appear acutely exhausted. 0 Patient did not appear
uncomfortable. 0 Body odor was normal.
AlP Written by @ 02 Apr 2007 1500 CST
Name:BEASLEY, RICHARD T
Sex: M Sponsor:
Rank:
Unit:
Outpt Rec. Rrn:
PCM:
Tel.PCM:
BEASLEY, RICHARD T
SPECIALIST 4 E4-A
WB60AA
FMP/SSN:
DOB:
PCat All USA AD
MC Status:
Insurance: No
TeIH:
TeIW:
CS:
WS:
CHRONOLOGICAL RECORD OF MEDICAL CARE STANDARDFORM 600(REV. 5)
Prescribed byGSA andTCMR
FIRMR
THIS INFORMATION IS PROTECTED BY THE PRIVACY ACT OF 1974 (PL-93-579). UNAUTHORIZED ACCESS
TO THIS INFORMATION IS A VIOLATION OF FEDERAL LAW. VIOLA TORS WILL BE PROSECUTED.
Page 1of2
HEALTH RECORD CHRONOLOGICAL RECORD OF MEDICAL CARE
02 Apr 2007 1438
Facility: WX63AA Clinic: 206 ASMC (ANACONDA) Provider:
1. visit for: follow-up exam
Comments: pt's wound was covered and silvadene was used.
Disposition Written by @ 02 Apr 20071501 CST
Released Without Limitations
Follow up: as needed in 2 day(s) or sooner ifthere are problems. - Comments: 1500 hours
Injury & Illness: Work Related; Onset Date: 4/2/2007; Battle Related; Category: Dermatological Cause: Battle Injury/Illness
Appointment Class: Outpatient
E&M Code: 99212 - Estab Outpatient Focused H&P - Straightforward Decisions
Signed By @ 02 Apr 2007 2025
WX63AA
Name:BEASLEY, RICHARD T
FMP/SSN:
DOB:
peat:
MC Status:
Insurance: No
Sex:
TelH:
reiw:
CS:
WS:
M Sponsor:
Rank:
Unit:
Outpt Rec. Rm:
PCM:
TeI.PCM:
BEASLEY, RICHARD T
SPECIALIST 4 E4-A
WB60AA
CHRONOLOGICAL RECORD OF MEDICAL CARE STANDARD FORM 600 (REV. 5)
Prescribed by GSA and ICMR
FIRMR
THIS INFORMATION IS PROTECTED BY THE PRIVACY ACT OF 1974 (PL-93-579). UNAUTHORIZED ACCESS
TO THIS INFORMATION IS A VIOLATION OF FEDERAL LAW. VIOLATORS WILL BE PROSECUTED.
Page 2 of2
'
1 - 7 - (' S ; I ' : t 0 :

1{/J OU.,. / OU4
Evaluation dates: 19 & 21 Jan OS

Neuropsychological Assessment
Walter Reed Army Medical Center
Neuropsychology Servlces
6900 Georgia A venue - Bldg 6, Room 30S5
Washington, D.C. 20307
Tel: (202) 782..0065
Fax: {202) 782- 7165
f2t ReferraJ:. SFC James Burns is a 34 year-old, Caucasian male who is approximately 8
. .:: post Sarin (GB) nerve agent exposure, while serving in OlF.
li! f a : SFC Bums was exposed to Sarin in May 2004, when handling and

transporting an lED in Iraq. Specifically, SFC Burns reports that he and his partner, both Explosive
Ordinance Disposal specialists, were called to the scene of an lED explosion when it was believed that
there was a risk for a secondary explosive in the spent device. He states that he picked up the device
wearing gloves, Wlaware that it had contained Sarin. Once he and his partner detennined there was no risk
a secondary they placed the device in their vehicle and transported it back to their site.
this approximately 15 minute drive he states that they both began experiencing symptoms
suggestive of exposure, to include nausea, headaches, blurred vision, motor incoordination,
decreased visuai field, and confusion. Upon arrival at their unit they walked to the medical clinic to seek
"' SFC Burns reports that it was during this time that his confusion increased significantly, and his
__ v;: t:1e events over the next two days is "fuzzy.', He reports that he does not believe he received an
-='Pi:le injection, but lmows he received a shower, oxygen, and eye drops. Medical records note the use
of atropine ophthalmic ointment. SFC Bums remained inpatient for two days and was placed on quarters
for two weeks. He states that his eyesight returned to nol'rnal during this time, but that it took several
weeks for his stamina and endurance to return. Available medical records note that twelve days after the
incident his symptoms were resolved or resolving. However, this specifically referred to the fact that he
1ad been headache free for two days, and that his vision had returned (although records note that after 30
o: reading he'd experience ocular pain). SFC Bums remained in haq until August 2004, when he
.:cLu ... 1"lled to the states with his unit.
Currently SFC Bwns reports the following persisting symptom.S: brief headaches that occur daily and
t'ass without intervention; decreased manual motor dexterity (he's apt to drop utensils, tools, pencils,
imbalance (he has fallen when bending to tie his shoes, trips downstairs
1
and has bumped into the
..va:J. in a hallway when carrying his 5 year-old); and difficulty with "recalling things." Examples he
provides for recall difficulties include forgetting to pick up his 5 year-old from the bus stop twice, the first
.timc having left work (approximately 1 mile from home) with the specific intent to pick him up but
having driven on to another task not remembering his intended task until 10-15 minutes later. SFC Burns
1 c:;<' reports decreased ability to multi .. task and a decreased "sense of direction'' as evidenced by having
recently become lost in a very familiar hunting/hiking location. SFC Burns reports that be believes these
sytnptonls have generally remained stable since his acute recovery from the exposure. He states that when
he dropped iten1s during his. remaining months in Iraq he simply assumed that it was due to his gloves and
the high temperature there, however since the symptoms remained upon his return he has become
concerned. He denies any change in emotional well being, personality, language functioning,
. ., r functi oning. He continues to work a full duty day at Pine Bluff Arsenal, however he is not
.-:-:: :""":--Jitted to work with explosives or handle a weapon.
Bums, James

DOB:

USA
M
)
-
(

AFOD-BE
DEPARTMENT OF THE ARMY
752nd Ordnance Company (Explosive Ordnance Disposal)
79th Ordnance Battalion (Explosive Ordnance Disposal)
Pine Bluff Arsenal, Arkansas 71602
MEMORANDUM FOR RECORD
SUBJECT: Current Medical Complications of SSG James F. Burns
1 Dec 04
1. Since returning from Operation Iraqi Freedom, 10 Aug 04, I have been dropping
items such as tools, soda cans, cups of water, pens, and pencils. I will stumble or
nearly fall while standing up from a chair or turning around to change directions. While
speaking, I will stutter or stammer and loose my thought in mid-sentence. In addition to
these, I tend to be very forgetful and have very little short term memory.
2. I will get headaches that do not last very long but are more intense after physical
training, mainly running. I will also feel a tingling sensation in my legs and hands on
occasion but will subside after a short while.
3. POC is the undersigned at DSN
JAMES F. BURNS
SSG, USA
Team Leader
-
JOI TER NURSING REC
(All haded area mandatory for Joint Theater Trauma R&gistry data collection)

. ' .
......... Resus Care/Theater ........
10 WRJST BAND ON

AIRWAY BREATHING Breath Sounds CIRCULATION DEF CIT/NEURO
Alert
0 Str1dor 0 Labored C Clear 0 D Warm DCool 0 Hot 0 Responds to Verbal
0 Drooling 0 Absert 0 Rales 0 0 Pink D PaJe 0 Cyanotic 0 Responds to PaJn
0 Obstructed 0 Retraction 0 Wheeze 0 0 Dry D Moist 0 Diaph 0 Unresponsive
0 Oral/Nasal Airway 0 Franng 0 Absent 0 Heart Sounds: GCS l$
0 BVM 0Ciear D Muffled Eyes I 4 Verbal I 5
0 Combi Tube Trachea: r idline CDev1ated CapJlla : Motor I 6 Total I 15
0 Intubated Chest Symmet : {circle one) 0 second (normal) Sphincter Tone
0 Other. Left> ual ht 0 >2 seconds del ed O WNL 0 Weak O None
SECONOAR"' SURVEY.
___________ INAUGU
Drainage: Rhythm: fat
ose {color 0 NSR (tachy/brady) 0 Distended
CSF I - 0 V-flbl lach 0 Obese
E)eS Equal R 1 L
O'h r
Ftxed R 1 L
Reactve R I L
Dilated R I L
-----
CSpme Tender
y s 0
Dental InJury
Yes O No
0 PEA 0 Non-tender
0 Asystore 0 Tender
0 Other 0 Rrgid
Pulses; 0 Guarding
S = Strong D = Doppler 0 Rebound
W = Weak A = Absent Tenderness
Caro 1d R __ L 0 Unable to
Femoral R __ L Assess
Brachtar R __ l 0 Open Wound
Radtal R __ L
Pelvis Stable:
DYes 0 No
Binder:
0 Yes ,._,
ood at
eatusNagina:
fJ Yes 0 No
EXTREMITIES
Fracture/Dislocation:
O RUE 0 RLE
O LUE 0 LLE
otor
RU + I
LUE + I
RLE + I
-
LLE + I
LOG ROLL TIME:
Back exam:
0 WNL
ns
I
I
I
I
..
..,
..
..
OM
I
I
I
I
. Tympan c
Clear R L
Blood R L
Pedal R __ L FAST DONE: S I NEG I NA
0 ABNL (describe)
JVO Distension:
Flail
Pft TII:LtT
DUKETT, PHILLIP
'-
( 332 EMOG, AFTH, SALAD AB, Iraq
MTF Transferred from. MTF:
MED CURRENT MEDICATIONS

nown Cl Unknown
one one
0 Respiratory hx 0 List Current Meds
0 Seizure hx
0 Cardiac hx
D HTN
D DM
0 Ulcers
0 Other.
SubjeCt fo the Pnvacy Act of 1974 Pa e 1 of 3



-
-
-


I

"'
SECONDARY SU
(AB)rasion
(AMP)utation
(AV)ulsion
(BL)eeding
(B) urn
(C)repitus
(D)eformity
(DG)Degloving
(E)cchymosis
(FX)Fracture
(F)oreign Body
(GSW)Gun Shot Wound
(H)ematoma
(LAC)eration
(PW)Puncture Wound
(P)ain
(SS)Seatbelt Sign
(SW)Stab Wound
PRE-HOS
PROTE

Neck Protetor: ""'
ET Intubation
(Adnl changes in Notes)
Urina
Chest tub
A-fi ne
Thoracotom
R L
. . '
,-....... >Fitifih
Teeth
D
D
D
oral
nasal
oral
D nasal
Amt D meatus
---
Color D su ra.
L R
L R
L R
L R

Site:

. L
R
0 ETC0
2
Change
0 BBS Post Int.
D Verified
Suction Y N
Heme Dip+ I-
Results cc
Air Bood
Air Blood
Time Test Time Test Time # Gau e IVF

ABG T & C x
Chemist UA
PT/PTT HCG
TEG Other
: rst/
nt 10./SSN:'
SD(HA) September 05 332nd EMDG. Balad AFTH
Subject to the Privacy Act of 197 4


TIME TYPE TIME TYPE
Chest
Head
Abdom.
Chest
Abdom.
Pelvis
Pelvis
Extrem.

02 on:
02 off:
Nasal cannula
NRB Mask 0
BVM D
AmtU
Amt In

Total:
8 ,. ,

Page 2 of 3

PATIENT MOV . JVlt:.l'ff .. KECORD
DATA BY PRIVACY A CT OF 1974 PERMANENT MEDICAL RECORD
(S) - Information needed to submit patient movement record
Sr-c.,...o "' 1
- C ) I I"' PATIENT !DENT!F!CATION
(s) NAME (Last, First, Middle Initial)
(s) SSN
(s) AGE
2.'{
(s) STATUS (s) SERVICE (s) GRADE
(s) UNIT OF RECORD AND PHONE NUMBER
M F A<""\'\'\'( E 0
Sc..h \6 -. s
SECTlON ll
VALIDATION INFORMATION
DATE OF BIRTH
CITE NUMBER
(s) Medical Treatment Facil1ty Origination and Phone Number
(s) Ready Date (Julian Date) APPOINTMENT DATE NUMBER OF ATTENDANTS
l- .
(s) ME (s) ON-MED
(s) Medical Treatment Facility Destination d Phone Nu ber
. ._-0 fV\a- l)l\; "- < \ Llt1
s) CLASSIFICATION 1A-5F
LITTER
AMBULATORY
(s) Reason Regulated Max# Stops ' Max# RONS Altitude Restriction s CCATI
I
SECTION HI
l
OTHER INFORMATION
(s) Accepting Physician name. Phone Number and e-mail

1c1an na
(s) Origlne1tlon Transportation 24 Hour Phone Number (s) Destination Transportation 24 Hour Phone Number
(s} Insurance Company Address Phone# Policy#
Relationship to policy holder
(s) VJaivers (med equi p, etc)
SECTION IV

CLINICAL INFORMATION
(s) Allergies
LABS (Date and time drawn in Zulu)
Nlt..oA
WBC HGB H CT Other Labs
(s) WEIGHT: (S) Blood type Vital Signs (Date and time taken in Zulu)
battle casualty disease Date Time (Zulu) Pulse Resp Pain Levei:
f,( /10
Last Pain Med: 0
2
/LPM: Route:
....... ry _ __.__ ____ AU
l
1/64
CLINICAL ISSUES
I
I
Baseline 02 Sat If Applicable
Infection Control Precautions: LMP:
Date of last bowel movement:
I
High Risk for Skin Breakdown yes no
Initial appropriate boxes:
Yes No

es No
Vision Impaired Voiding difficulty
Cardiac Hx *Takes long-term meds
Diabetes *Will sef-medicate
I
I
Temp
SPECIAL EQUIPMENT (Check all that apply}
Suction Traction Orthopedic devices GTHER:
Ventilator Ventilator Settings:
DiET iNFORMATiON (Check ali that
NPO Soft Full Lig Cl Liq
-
Meq K
- -
Renal Gm Protein Gm Na
Mag Sulfate
-
- -


cc/hr Discontinue for Fiight
Tube Feeding Type
Motion Sickness Has adequate supply of med

TPN:
Ears/Sinus Problems Knows how to take meds

Respiratory difficulty (verbalized understanding)
Cardiac Diabetic
cal Infant formula: Pediatric Age:
*Medication listed on physician's orders
Other( specify):
SECTION V
PERTINENT CLINICAL HISTORY (Transfer Suml'pary)
V.VU 'k_. kQ o C.. h fi\Wf-Cll <d d 1\. l t Jl U {, V :
W'W\LW\ ,j(l.f. -l2.a_ B 1 " Nov L_, :-+}, 1
"
-

l t W (tJI\-' " t7' (,c_ bY\ I u.S
) "V' , '
Physician's Signature
I
Dateffime
Dateffime
Av6 o<o u
Signature of Clearing Flight Surgeon
AF IMT 3899, 20060819, V1
PATIENT MOVEMENT RECORD (conti nuation}
DATA PROTECTED BY PRIVACY ACT OF 1974 PERMANENT MEDICAL RECORD
PATIENT MOVEMENT PHYSICIAN ORDERS {for continued care in the AE system and at enroute stops)
SECTION I. PATIENT IDENTJFI CATION
1. NAME (Last. First, Mrddle Initial)

2 GRADE 3 SSN#
4. ALLERGIES
I
5. ORIGINATING MTF
6. DESTINATIO MTF
...
..
SECTION ll. MEDICATION ORDERS (Drugs and IVs) SECTION Ill. OTHER ORDERS (ProceduresJ TreatmentJ V/S Frequency, ETC}
yes
no patrent will self-medrcate
w1th the followrn medrcalions:
0 ~ Diagnosis:
I
i
erate 0 Severe 0
. a to ogy Results:
PAS

. -

J
I
I

. ACYACTOF
\ \'f. (last Flrst,Middle Initial ) 1974
PROGRESS NOTE
PERMANENT MEDICAL RECORD
ETT, PHILIP J
DATE/TIME(ZULU)
NOTES
History:
A/E DWMMC 233 M t d G
. 2008 092 0. TBI Scree n: Negative. DOI:16AUG08. C/ C: Pt exposed t o us ar as
whlle handling unexpl oded munitions. Was Decon in Bal ad. Sustained large painful blist e rs
to R thl h. rr1ved LRMC on 19AUG08 t o Internal Medicine / Dermat o logy Evaluat e d :
Dx : R Thigh Mu s t a rd Ga s Exposure. Plan t o TCC CONUS for : >60 day me dlcal
management . Denies PMH: PSH:. Asse ssment: AOx3 , NAD. Ambulates with mini mal diffi cul ty.
now open, covered wi th cream a nd d r e s s ing. Dr essi ngs not saturated, c hanging
Can tol erate prolonged s itting . Pa in is s ignifi cantly decreased with oi ntme nt. 1:10
Wlth meds, 3:10 without meds. Wi l l have a mpl e supply o f meds and can self medicated as
needed. No other physical l i mi t a tion s . No discomfort wi t h flying. Has Mil ID for travel.
No vis1ble wounds or b r uises . Can egress/ d i gress AC wi t hout a s sistance . Can c arry own bag s
and Wlll use cart at airport. Use of s t a nda rd and MRSA contac t p r e c a u t 1ons for
Ac inotebactor as per AFI 41 - 307 ATCH 12. May fly c ommer c i a l as per MD n o te I highly
recommended DWMMC AE. Saf e Flight . CDR NC USN. Pt pref erence is :
DWMMC PROGRESS NOTES
DO NOT REMOVE
(REVERSE)
Vers1on 1 0 0.0
PHYSICAL PROFILE
For use of this form, see AR 40-501 ; the proponent a ency is the Office of the Suroeon General.
u i
1. MEDICAL CONDITION: (Description in lay terminology) 0 1NJURY? Or 0 ILLNESS/DISEASE? 2. CODES (Table 3. P
1 7-2 AR 40-501) Temporary 3
s'p k1dney removal left ,.
~
Permanent
4. PROFILE TYPE
- --- -
- - ---- --
a TEMPORARY PROFILE (Expiration date YYYYMMDD)
(Limited to 3 months duration)
----
2009/11/05
-
- - - -
b PERMANENT PROFILE (Reviewed and validated as a minimum with every periodic physical exam or after 5 years from the date of issue) _ _
- -
~ c IF A PERMANENT PROFILE WITH A 3 OR 4 PULHES, DOES THE SOLDIER MEET RETENTION STANDARDS lAW CHAPTER 3 AR 40-50
1
?
(IF USARIARNGIARNGUS SOLDIER NOT ON ACTIVE DUTY SEE PARA. 9-10 & 10-26, AR 40-501 1F SOLDIER DOES NOT MEET RETENTION STANDARDS.)
5 FUNCTIONAL ACTIVITIES FOR PERMANENT AND TEMPORARY PROFILES (If any answer (a-f) is NO then the profile should be at least a 3)
- -- -- - - - -
- - - - - -
a ABLE TO CARRY AND FIRE INDIVI DUAL ASSIGNED WEAPON
-
- - -
- - -
f. IS SOLDIER HEAL THY WITHOUT ANY MEDICAL CONDITION THAT PREVENTS DEPLOYMENT?
6 APFT YES NO ALTERNATE APFT (Fill out if unable to do APFT run otherwise NIA)
- -
N/A
~
N/A
--
N/A
--- --------- ----t--
--
-
2 MILE RUN APFT WALK
./
----4-----+- ---
./ APFT SWIM
----------- ~ -----+- - -1--- ---
./ APFT BIKE
-
APFT SIT -UPS
-
APFT PUSH UPS
7. STANDARD OR MODIFIED AEROBIC CONDITIONlNG ACTIVITIES (Check all applicable boxes)
-.--
L H
1
E ' S
L ~
1 1 l 1 1
YES NO
-
r-
./
-
./
./
YES NO
-
./
./
-
./
- -- - ---- -
-
-
-
--
-
-
UNLI MITED RUNNING OR RUN AT OWN PACE & DISTANCE ------+--- ./
UNLI MITED WALKING OR WALK AT OWN PACE & DISTANCE -- ,/
--4-----
UNLIMITED BIKING
-- /
OR BIKE AT OWN PACE & DISTANCE v
- --------+-_:_--+----
I-
UNLIMITED SWIMMING OR SWIM AT OWN PACE & DISTANCE ./
8. UPPER BODY WEIGHT TRAINING (See FM 21-20)
1
./
1
9. LOWER BODY WEIGHT TRAINING (See FM 21-20) I ./ I
10. OTHER e.g. Functional hm1tattons and capabilities and other comments: (May continue on page 2) 11 . THESE PARAMETERS ARE OPTIONAL USE AS NEEDED
PT to tolerance Crunches ok. No sit-ups. Lifting or carrying max weight 45 or d'stance
No gear
Th1s temporary profil e is an extens1on of a temporary profile fi rst issued on
12 TYPE NAME & GRADE OF PROFILING OFFICER
Amy E Hawkins, MPAS, PA-C CPT, SP
15 ACTION BY APPROVING AUTHORITY
16. TYPE NAME & GRADE OF SENIOR PROFILING OFFICER OR APPROVING AUTHORITY
19. ACTION BY UNIT COMMANDER (See para 7-12, AR 40-501)
-
THIS PROFILE REQUIRES A CHANGE IN THIS SOLDIER'S MOS or DUTY ASSIGNMENT
20 COMMENT
.I
Runni ng maximum distance tolerance
Prolonged standing - maximum time per episode
Marching with standard field gear except rucksack max distance
Impact activities such as jumping max# reps in one day
RE
:> 14. DATE (YYYYMMDD)
2009/10/15
APPROVED
I
NOT APPROVED
17. SIGNATURE
18. DATE (YYYYMMDD)
YES NO
~ -----\-c
~
1f this is a per. nanent orofile with a PULHES senal of 3 or 4 refer to block 4c
21 . TYPED NAME & GRADE OF UNIT COMMANDER 22. SIGNATURE
23. DATE (YYYYMMDD)
24. PATIENT'S IDENTIFICATION (For typed or wotten entries gtve Name(last, first), grade, SSN;
hosp1tal or med1cal facility)
Dukett, Phili James
SGT
SBTMC
25. UNIT
WALUBO - 0014 IN BN 01 B CO
26. ISSUtNG CLINIC, PROVIDER E-MAIL & PHONE NUMBER
PROFILING OFFICER (Or Approving Authority if applicable) IS
RESPONSIBLE FOR ENSURING THE PULHES & DATE OF PROFILE ,
5
ENTERED INTO MEDPROS. ORIGINAL COPY POSTED IN MEDICAL
RECORDS, 1 COPY TO UNIT COMMANDER, 1 COPY GIVEN TO
SOLDIER, 1 COPY TO MILPO.
DA FORM 3348, FEB 2004 OA FORM 3349 MAY 86 IS OBSOLETE
THIS INFORMATION IS PROTECTED BY THE PRIVACY ACT OF 1974 (Pl-93-579). UNAUTHORIZED ACc'ESS TO THIS INFORMATION IS AVIO APO V1 .01 Page 1 of 1
LATION OF FEDERAL LAW. VIOLATORS WILL BE

-
ct'lv U'=>UKt: L UK Uo-XXXX

All rCQuncd ctem.) oo tht lst
1. Narno (L s t. Jrst. Ml)
c
Li D
4 ..
dl 5. Date ctur n to Hood S. Re(iuested L v 0 tos
8. .. m. il Addr ..,.., (AKO)
9. S p. ration 0 t (Frorn

1.00
tton
Turn n Records with DO Form 2766 Insert u
*Schedule Household Goods Derive as
ep ration te (From Army}
11 07
complete On-line OOIM Users training (for Hood e-maH accoont holders)
Reactivate Auto Insurance
Update expired drivers license I vehicle registration I TX vehide inspection
Signature Title
CDR 11SG Signatu,.. & Date
7. Origin I Deployment Date
11. Orders fn Hand
ES I
Date
More information on these topics can be found in the Iraqi Freedom Reintegration Handbook included in your -.wlcome packet