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OCR Page 1 of 3Standard Form 520
Promulgated August 1948
By Bureau of the Budget
Circular A-32
CLINICAL RECORD
PREVIOUS ECG
LECTROCARDIOGRAPHIC REPORT
YES
NO
CLINICAL IMPRESSION
MEDICATION
EMERGENCY
BEDSIDE
ROUTINE
AMBULANT
AGE
SEX
RACE
HEIGHT
WEIGHT
B.P.
SIGNATURE OF WARD PHYSICIAN
DATE
1800
WILLIAM H. GRAHAM, Brig. Gen. MC
20 Sep 49
RHYTHM
AXIS DEVIATION (QRS)
RATES
Normal sinus
Normal
AURIC. 65 VENT. 65
INTERVALS
P WAVES
PR 0.20-0.22 QRS 0.8
QT
--
Normal
QRS COMPLEXES
Normal shape and duration
RS-T SEGMENT
T WAVES
Normal
T3 low, variable
PRECORDIAL LEADS (Specify)
V1-V6 and IVF; augmented unipolar extremity leads not recorded
SUMMARY, SERIAL CHANGES, AND IMPLICATIONS:
Only
electrocardiographie abnormalities present are a slight and variable prolongation
of A-V conduction time (incomplete heart block), which has been, if I recall, present
in some tracings made previously. No ECG evidence of acute myocardial ischemia or
injury or other abnormalities are noted.
NO.
SIGNATURE
Davity
TITLE
DATE
ECG
AMES S. TAYLOR, Colonel MC
20 Sep 49
IAL
10
MOUNT TRACINGS HERE
(Continue on reverse)
PATIENT'S LAST NAME-FIRST NAME-MIDDLE NAME
REGISTER NO.
WARD NO.
ELECTROCARDIOGRAPHIC REPORT
(NAME OF HOSPITAL OR OTHER MEDICAL FACILITY)
Standard Form 520
U. s. GOVERNMENT PRINT'NG OFFICE
16-56209-1
adams States,
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