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Ford, Gerald - Interval Six-Month Physical - January 24, 1976
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Ford, Gerald - Interval Six-Month Physical - January 24, 1976
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The original documents are located in Box 37, folder "Ford, Gerald - Interval Six - Month
Physical - January 24, 1976" of the Betty Ford White House Papers, 1973-1977 at the
Gerald R. Ford Presidential Library.
Copyright Notice
The copyright law of the United States (Title 17, United States Code) governs the making of
photocopies or other reproductions of copyrighted material. Betty Ford donated to the United States
of America her copyrights in all of her unpublished writings in National Archives collections.
Works prepared by U.S. Government employees as part of their official duties are in the public
domain. The copyrights to materials written by other individuals or organizations are presumed to
remain with them. If you think any of the information displayed in the PDF is subject to a valid
copyright claim, please contact the Gerald R. Ford Presidential Library.
THE WHITE HOUSE
WASHINGTON
January 21, 1976
Instructions: No breakfast on Saturday
CONFIDENTIAL
ANNUAL PHYSICAL EXAMINATION
President Gerald R. Ford
Saturday, January 24, 1976
National Naval Medical Center
Depart Residence
7:30 am
Arrive Bethesda and Proceed to Presidential Suite
8:00 am
Laboratory Tests - Urinalysis - Electrocardiogram
8:00 am
Breakfast
8:30 am
X-Ray Department (Chest, KUB, Knees, Sinuses)
8:45 am
History, Physical Examination and Sigmoidoscopy - Dr. Lukash
9:00 am
Orthopedic Consultations
9:45 am
Eye Clinic
10:00 am
ENT (Examination in Suite)
10:15 am
Eye Clinic Return
10:45 am
Depart Bethesda
11:15 am
Arrive Residence
11:45 am
Wm Lukash
William M. Lukash, M.D.
Rear Admiral, MC, USN
Physician to the President
Terry O'Donnell
Military Office
Ron Nessen
Bill Nicholson
Ron Jackson
Mrs. Ford
DECLASSIFIED
President's Study (Second Floor)
E.O. 13526 (as amended) 8EC 3.3
Chief Mc Whirter and Weaver
NSC 3/30/06, State Dept. Guidellnes
By MD. NARA, Date 2/24/2016
Admiral Brown
Captain Seaton (Eye)
Captain DeFries (ENT)
Captain Ochs (X-Ray)
CONFIDENTIAL
Captain Slemmons (Ortho)
Standard Form 502
Rev. August 1954
Bureau of the Budget
Circular A---32
CLINICAL RECORD
NARRATIVE SUMMARY
DATE OF ADMISSION
DATE OF DISCHARGE
NUMBER OF DAYS HOSPITALIZED
(Sign and date at end of narrative)
Annual Physical Examination - President Gerald R. Ford - - 24 January 1976
National Naval Medical Center, Bethesda, Maryland
Age: 62
Birth Date: July 14, 1913
The President's last annual physical examination was held on January 25, 1975.
During the last year the President has continued to experience good health with
the exception of the following problems:
Problem #1 Post-Surgical Knees - The President had no difficulty with
his knees throughout the year and continued to follow an active program of
quadriceps strengthening. His skiing vacation in Vail this Christmas was limited
to seven days. It appeared that he skied stronger than at previous times and had
no difficulty except for some residual swelling on the lateral portion of the left
knee. This caused some mild discomfort but did not interfere with his skiing and
responded to treatment with Butazolidin. The discomfort resolved after returning
home within two or three days.
Problem #2 - Acute Right Maxillary Sinusitis - In October the President
developed a common cold and this became complicated when he developed an
acute sinus infection in the right maxillary sinus on October 19. His activity
was restricted to the White House living quarters for three days and the condition
responded to conventional treatment and there have been no after affects other
than his tendency towards occasional nasal congestion and this is associated with
a post-nasal drip and sporadic episodes of sneezing. This responds to the use
of an oral decongestant tablet which he will take the night before going to sleep.
Problem #3 - Assassination Attempts - In the month of September, on
September 5 and 22, two very serious assassination attempts were directed
toward the President in both Sacramento and San Francisco. The President
suffered no ill effects either physically or emotionally. I was not aware that
he had any undue preoccupation concerning these events. The President was
able to talk freely about these incidents and continued to sleep very well and I
feel in no way did they affect his subsequent day to day activity.
(Use additional sheets of this form (Standard Form 502) if more space is required)
SIGNATURE OF PHYSICIAN
DATE
IDENTIFICATION NO.
ORGANIZATION
PATIENT'S IDENTIFICATION (For typed or written entries give: Name-last, first,
REGISTER NO.
WARD NO.
middle; grade; date; hospital or medical facility)
FORD, President Gerald R.
NARRATIVE SUMMARY
Standard Form 502
372-28-6532
502-108
2
Standard Form 502
Rev. August 1954
Bureau of the Budget
Circular A---32
CLINICAL RECORD
NARRATIVE SUMMARY
DATE OF ADMISSION
DATE OF DISCHARGE
NUMBER OF DAYS HOSPITALIZED
(Sign and date at end of narrative)
Problem #4 - Lesion on left upper eyelid - A small wart-like lesion on the
left upper eyelid was removed in the White House office on December 3, 1975.
The diagnosis was that of benign seborrheic keratosis. The excision site healed
completely.
Problem #5 - Muscle Cramp, Left Calf - On December 20, 1975 the patient
was awakened early in the morning because of a severe cramp in the left calf.
This responded to rest and treatment with hot packs and ultrasound and massage.
There has been no recurrence.
Problem #6 - Rectal Bleeding - The President has noted with bowel movements
that occasionally small flecks of blood will appear on the toilet tissue. This has
occurred from time to time in the past and is usually associated with excessive
fatigue and prolonged activity while traveling. Examination on proctoscopy
revealed minimal friability of the anal canal as the result of previous surgery for
a hemorrhoidectomy and anal fistula 30 years ago. There has been no re-
currence. A barium enema was performed in 1974 and was normal.
Present Health
The President has continued to maintain his tremendous physical capacity for
hard work without any difficulty. His cardiovascular functions remain excellent
and he is able to tolerate more than regular exercise without difficulty. There
have been no respiratory complaints and he has had no dyspnea or cough. His
appetite remains good and he has maintained his weight at 194 pounds without
difficulty. His bowel movements are regular every morning. Other than an
occasional mild discomfort in his knees after excessive activity, his muscular
skeletal system functions remain well. In general the President works long
hours but he sleeps very well and feels completely refreshed upon awakening.
Exercise Program
GJARBO
After awakening every morning at 5:30 am the President participates in his
exercise routine. This includes: (1) Quadriceps strengthening by lifting
weights with both knees. He will lift 20-40 pounds with repetition, ranging
(Use additional sheets of this form (Standard Form 502) if more space is required)
SIGNATURE OF PHYSICIAN
DATE
IDENTIFICATION NO.
ORGANIZATION
PATIENT'S IDENTIFICATION (For typed or written entries give: Name-last, first,
REGISTER NO.
WARD NO.
middle; grade; date; hospital or medical facility)
FORD, President Gerald R.
NARRATIVE SUMMARY
372-28-6532
Standard Form 502
502-108
Standard Form 502
3
Rev. August 1954
Bureau of the Budget
Circular A---32
CLINICAL RECORD
NARRATIVE SUMMARY
DATE OF ADMISSION
DATE OF DISCHARGE
NUMBER OF DAYS HOSPITALIZED
(Sign and date at end of narrative)
from 20-40 lifts per knee daily. In addition he pumps his exercycle the
equivalent of one-half mile with additional resistance added to the pumping. This
is followed by about 10 minutes of calisthenics. He continues to swim every
evening and now swims 22 lengths for one-quarter mile which he does in 14
minutes.
Past Medical History
Cartilage Surgery, left knee - - 1929; right knee - 1972. Appendectomy, anal
fistulectomy and hemorrhoidectomy 30 years ago. The President had his annual
influenza shot. His medications include an occasional sleeping tablet while
traveling and an oral decongestant from time to time for nasal congestion. He
smokes 6-7 pipe loads of tobacco a day and he will have an evening cocktail
consisting of no more than 2-4 ounces of alcohol in the evening. No allergies.
Family History
Mother died at age 71, myocardial infarction; father died age 72, stroke.
Three half brothers all healthy. Mother had mild diabetes at old age.
Review of Systems:
Eyes - The President requires glasses only for distant vision and at this
point has no requirement for near vision reading glasses.
Ear, Nose and Throat - With the slight deviation of the nasal septum and
sensitive nasal mucosa, he will have a nasal congestion from time to time
with exposure to the cold air. This may cause him to sneeze and result in
post-nasal drip on awakening. Auditory acuity normal.
Pulmonary - No dyspnea or cough.
Cardiovascular No chest pain, palpitation, shortness of breath or edema.
Gastrointestinal No indigestion or abdominal pain. His bowel movements
(Use additional sheets of this form (Standard Form 502) if more space is required)
SIGNATURE OF PHYSICIAN
DATE
IDENTIFICATION NO.
ORGANIZATION
PATIENT'S IDENTIFICATION (For typed or written entries give: Name-last, first,
REGISTER NO.
WARD NO.
middle; grade; date; hospital or medical facility)
NARRATIVE SUMMARY
FORD, President Gerald R.
Standard Form 502
372-28-6532
502.108
4
Standard Form 502
Rev. August 1954
Bureau of the Budget
Circular A--32
CLINICAL RECORD
NARRATIVE SUMMARY
DATE OF ADMISSION
DATE OF DISCHARGE
NUMBER OF DAYS HOSPITALIZED
(Sign and date at end of narrative)
are normal but on rare occasions he will note rectal bleeding evidenced by
blood flecks on toilet tissue and related to excessive activity, fatigue and
straining with a bowel movement.
Genitourinary Nocturia one time per night but with no urgency or discomfort.
Sexual function normal.
Neuromuscular - Other than mild discomfort in his knees with excessive
activity and occasional stiffness in the left cervical area, he has had no other
muscular joint problems.
Neurological - No headaches or tendency towards depression or anxiety.
Skin - No skin lesions.
Physical Examination: Patient appears to be in an excellent state of health
and nutrition. Height: 72 inches; weight: 194 pounds; blood pressure:
120/74; pulse: 60; temperature: 97.8.
Eyes - Pupils are round, regular and react to light and accommodation.
Extraocular movements normal. Ocular fundi normal. Nearsightedness
and glasses required for distant vision. Ocular pressures normal. TOD
16, TOS 14.
Ears - Normal external ear canals. Ear drums are normal. Transillumination
of paranasal sinuses is clear and there is no evidence of sinusitis or rhinitis. Hearing
good.
Nose - Slight deviation of the nasal septum. The mucosa appears normal.
Mouth - Teeth are in good repair although there is dark tobacco staining.
There is no mucosal abnormality involving his palate.
Neck - Neck is supple with good range of motion. Thyroid not enlarged.
No lymph nodes. Carotid artery pulsations equal without bruit.
(Use additional sheets of this form (Standard Form 502) if more space is required)
SIGNATURE OF PHYSICIAN
DATE
IDENTIFICATION NO.
ORGANIZATION
PATIENT'S IDENTIFICATION (For typed or written entries give: Name-last, first,
REGISTER NO.
WARD NO.
middle; grade; date; hospital or medical facility)
FORD, President Gerald R.
NARRATIVE SUMMARY
Standard Form 502
372-28-6532
502.108
5
Standard Form 502
Rev. August 1954
Bureau of the Budget
Circular A---32
CLINICAL RECORD
NARRATIVE SUMMARY
DATE OF admission
DATE OF DISCHARGE
NUMBER OF DAYS HOSPITALIZED
(Sign and date at end of narrative)
Breasts Negative.
Lungs - Clear and resonant to percussion and auscultation. Chest expansion
good and diaphragms move normally.
Heart - No abnormal heart sounds. No cardiomegaly or precordial lift and a
well localized PMI. No murmurs or gallop sounds were heard. Second heart
sound normally split.
Abdomen - Soft and non-tender. No masses. Liver and spleen are not
enlarged. Liver span was 12 cm in the mid-clavicular line. Right appendix
scar was intact. Inguinal rings were normal. No abdominal bruits.
Rectal - Very small hemorrhoidal tags. Sphincter tone good. Prostate normal
size, smooth, and non-tender. Feces were brown and formed. The hematest
was negative. Proctoscopy normal to 25 centimeters. The mucosa of the
distal anal canal was intact but hyperemic and slightly friable.
External Genitalia - Testicles normal and symmetrical.
Neuromuscular Examination - The cervical spine and shoulder joints retain
good mobility with no pain. Both knees show minimal restrictions of full
extension and flexion. There is also non-painful patellofemoral crepitation
with pressure motion of both knees. The knees are basically stable with no
joint tenderness and supporting ligaments are intact. Chronic synovial
thickening was apparent in both and was associated with a very slight degree
of effusion in the left knee.
Neurological All deep tendon reflexes are active and equal. Muscle and
sensory function were intact and there were no pathologic reflexes.
Laboratory Tests All the laboratory tests were normal. The Hgb was 15. 2
grams and the Hct was 45 vol %. The WBC was 5, 300 with a normal
differential count. Values of SMA-12 and SMA-6 were normal. Uric acid is
7.4 mg % and the cholesterol 275 mg % with triglyceride 115 mg %. The
(Use additional sheets of this form (Standard Form 502) if more space is required)
SIGNATURE OF PHYSICIAN
DATE
IDENTIFICATION NO.
ORGANIZATION
PATIENT'S IDENTIFICATION (For typed or written entries give: Name-last, first,
register NO.
WARD NO.
middle; grade; date; hospital or medical facility)
NARRATIVE SUMMARY
FORD, President Gerald R.
Standard Form 502
502-108
372-28-6532
6
Standard Form 502
Rev. August 1954
Bureau of the Budget
Circular A--32
CLINICAL RECORD
NARRATIVE SUMMARY
DATE OF admission
DATE OF DISCHARGE
NUMBER OF DAYS HosPITALIZED
(Sign and date at end of narrative)
lipoprotein profile remains normal. Urinalysis completely normal.
X-Rays - The chest X-ray remains normal. The paranasal sinuses are clear
with no evidence of sinusitis. The KUB abdominal film was normal. Both
knees reveal hypertrophic degenerative changes with slight loss of the joint
space about the lateral femoral condyles. No evidence of loose bodies is
present within the joint spaces. Post-surgical osteoarthritis is present in
both knees and degenerative osseous change is also present about the C 5-6
cervical spine.
EKG - EKG was normal showing no change.
Orthopedic consultation - The President has post-traumatic arthritis in both
knees, but has no pain and good function. He should continue his quadriceps
strengthening exercises which have been successful in maintaining knee
stability. In addition, two aspirin four times a day can be prescribed if
swelling or stiffness develops.
ENT Consultation - His sinuses are completely clear with no sequelae from
his recent sinus infection and post-nasal drip. There is no evidence of any
mucosal membrane abnormality related to his pipe smoking.
Ophthalmology Consultation . The President's eyes are completely healthy
and nearsightedness is correctable with his present glasses.
In conclusion, the President has remained in excellent health. He will
continue with his established diet and exercise program. It is anticipated
that the President will continue to have good health and he will be followed
at intervals to insure that his knees remain stable and that his weight has
not changed appreciably. In addition, he will be encouraged to play golf
or tennis for short periods of time and also swim daily as his schedule
allows.
(Use additional sheets of this form (Standard Form 502) if more space is required)
SIGNATURE OF physician
DATE
IDENTIFICATION NO.
ORGANIZATION
PATIENT'S IDENTIFICATION (For typed or written entries give: Name-last, first,
REGISTER NO.
WARD NO.
middle; grade; date; hospital or medical facility)
FORD, President Gerald R.
NARRATIVE SUMMARY
Standard Form 502
372-28-6532
502-108
7
Standard Form 502
Rev. August 1954
Bureau of the Budget
Circular A--32
CLINICAL RECORD
NARRATIVE SUMMARY
DATE OF ADMISSION
DATE OF DISCHARGE
NUMBER OF DAYS HOSPITALIZED
(Sign and date at end of narrative)
Final Diagnosis:
1. Post-surgical degenerative arthritis in both knees.
William m Lukash
William M. Lukash, M.D.
Rear Admiral, MC, USN
Physician to the President
(Use additional sheets of this form (Standard Form 502) if more space is required)
SIGNATURE OF PHYSICIAN
DATE
IDENTIFICATION NO.
ORGANIZATION
PATIENT'S IDENTIFICATION (For typed or written entries give: Name-last, first,
register NO.
WARD NO.
middle; grade; date; hospital or medical facility)
FORD, President Gerald R.
NARRATIVE SUMMARY
Standard Form 502
372-28-6532
502.108
THE WHITE HOUSE
WASHINGTON
January 24, 1976
HEALTH REPORT
I would like to report on the President's health over the last year
and also give the results of the President's Annual Physical
Examination that was completed today at Bethesda Naval Hospital.
During 1975 the President continued to experience good health and
was able to sustain the long hours and heavy responsibilities of
his office.
Last September, within a period of three weeks, two monstrous
and seemingly senseless assassination attempts were directed
toward the President while he was in Sacramento and San Francisco.
Fortunately, the President suffered no apparent physical or mental
ill effects. At no time did he appear preoccupied. He talked freely
concerning these events and was able to sleep without difficulty
and I feel the incidents in no way affected his subsequent day to day
activity.
In October the President suffered from a common cold that was
complicated by the development of a sinus infection. Because of
this, his activity was restricted to the residence for three days.
The condition responded to treatment and he has had no further
recurrence. In early December a small wart-like blemish was
removed from the President's left upper eyelid in my office. It
was diagnosed as a common benign lesion and healed completely.
The President's knees have maintained their strength and stability
and he skied with very little difficulty during the short vacation
at Vail this past year.
LIBRARY
CERALD
a
FORD
2
The President's weight is normal at 195 pounds and he has
continued a rigid program of exercise every morning with his
knee strengthening routine, consisting of lifting 20 to 40 pounds
at least 20 to 40 times with each knee. He follows this with
riding an exercycle at least half a mile and then an additional
ten minutes of general calisthenics.
At this time I would like to acknowledge those citizens in this
country who by their contributions have made it possible for
the President to have a White House swimming pool. He swims
22 laps, equivalent to one quarter of a mile in a time of 11
minutes, and does this every evening after leaving his office.
In my opinion the last three to four months have been the most
arduous for the President since he came into office. Throughout
this period he has worked 14-15 hours every day and including
every Saturday and Sunday. I know that the opportunity to end
this kind of day with an invigorating swim has played a very
important part in helping him to relax and enabling him to sleep
well and feel completely refreshed upon awakening the next day.
The President's physical examination today was normal, with
no unusual findings. Examination of his heart and circulatory
system again reveal an excellent blood pressure and slow pulse
rate generally seen in well-conditioned athletes. Both knees
are stable and show good mobility. The preliminary laboratory
tests are all normal with a satisfactory blood cholesterol level,
X-rays, and a stable electrocardiogram. My judgment is that
the President has maintained his excellent state of health and
capacity for long hours and all official responsibilities.
I would also like to report that Mrs. Ford had her routine four-
month cancer examination yesterday and she continues to remain
in good health and there is no clinical sign of any cancer recurrence.
It is most satisfying for a family physician to report the good
health of the Ford Family. As the First Family, they are all
fit and eagerly looking forward to actively participating in the
many events celebrating the 200th Birthday of our country
during this Bicentennial Year.
William Lukash
William M. Lukash, M.D.
LIBRARY
R.
Rear Admiral, MC, USN
FORD
Physician to the President
ME FORD, GERALD
INTERPRETATION:
MBER 372-28-6532
TE 24JAN76
AGE
L. Mormal Elictrocardiogram
D FORMAT
AVR V1 V4 X
RATE
PR
QRS
AVL
V2
V5
Y
QT.
AXIS
AVF
V3
V6
Z
DRUGS
2. then has been no change from a previous
OPTIONAL
SPLIT CAL. PULSE AT LEFT INDICATES
EKM dated 25 Jan 75.
1/2 STD. ON PRECORDIAL LEADS ONLY
W William P. Baber
FORD, GERALD
INTERPRETATION:
BER 372-28-6532
24JAN76
AGE
L. Mormal Electrocardiogram
ORMAT
RATE
PR
QRS
VR V1 V4 X
VL
V2
V5
Y
QT.
AXIS
VF
V3
V6
Z
DRUGS
2. then has been no change from a previous
OPTIONAL
PLIT CAL. PULSE AT LEFT INDICATES
EKM dated 25 Jan 75.
/2 STD. ON PRECORDIAL LEADS ONLY
William P. Baber
ELECTROCARDIOGRAPH REPORT
FORD, GERALD
INTERPRETATION: 1. Normal Electrocardiogram
372-28-6532
2. There has been no change from a previous EKG
dated 25 January 1975
b allian P. WSN
William P. Baker, CAPT, MC, USN
FORD & LIBRARY 06
Standard Form 513
Rev. August 1954
Bureau of the Budget
Circular A-32
S/N 0105-LF-201-2602
CLINICAL RECORD
CONSULTATION SHEET
REQUEST
TO:
FROM: (Requesting ward, unit, or activity)
DATE OF REQUEST
Eye Clinic
White House Medical Unit
24 January 1976
REASON FOR REQUEST (Complaints and findings)
Routine eye evaluation. No complaints.
PROVISIONAL DIAGNOSIS
DOCTOR'S SIGNATURE
APPROVED
PLACE OF CONSULTATION
EMERGENCY
Wm. m. Lukad M.D.
BEDSIDE
ON CALL
ROUTINE
Rear Admiral, MC, USN
CONSULTATION REPORT
Physician to the President
Present R
con
VA 00 05 20/20 20/20
0.75 spl - 1.00 eye X085
- 1.00 spl - 0.75 cyl X 090
near vision unarded 20/30 -
External exam normal had & odnexa
movements normal & full
Pupels - normal size & reaction
Shet lamp - - normal conner, luses t inde TOS14 Too 16
Funds Though dilated pupils
normal rises, nessels, moculos
and on seriotos
Impr: hormal ocular status
SIGNATURE AND TITLE
mild DATE (Continued IDENTIFICATION.NO side) ORGANIZATION (Wyohea)
on reverse
typed or written éntries give: Name-last, criested first, REGISTER NO. precent WARD spectade NO.
PATIENT'S IDENTIFICATION (For
middle; grade; date; hospital or medical facility)
Ford, President Gerald R.
S/N 0105-LF-201-2602
Ment CONSULTATION SHEET
The White House
Standard Form 513
513-104-02
372-28-6532
Standard Form 513
Rev. August 1954
Bureau of the Budget
Circular A-32
S/N 0105-LF-201-2602
CLINICAL RECORD
CONSULTATION SHEET
REQUEST
TO:
FROM: (Requesting ward, unit, or activity)
DATE OF REQUEST
REASON FOR REQUEST (Complaints and findings)
PROVISIONAL DIAGNOSIS
DOCTOR'S SIGNATURE
APPROVED
PLACE OF CONSULTATION
EMERGENCY
BEDSIDE
ON CALL
ROUTINE
CONSULTATION REPORT
The prendents eyes are completely healthy
He has a mild reportune her (near sight edness)
which in consectable to 20/20 mision by
his present glouses.
(Continued on reverse side)
SIGNATURE AND TITLE
DATE
IDENTIFICATION NO.
ORGANIZATION
PATIENT'S IDENTIFICATION (For typed or written entries give: Name-last, first,
REGISTER NO.
WARD NO.
middle; grade; date; hospital or medical facility)
S/N 0105-LF-201-2602
CONSULTATION SHEET
Standard Form 513
513-104-02
ENT EXAMINATION
Examination of the head and neck and ears, nose and throat is normal.
Despite a history of sinusitis in the past, at the present time the
examination of these areas is normal. X-rays of the sinuses are normal
as well.
FORD y LIBRARY
Standard Form 513
Rev. August 1954
CEB
Bureau of the Budget
Circular A-32
S/N 0109-201-2602
CLINICAL RECORD
CONSULTATION SHEET
REQUEST
TO:
FROM: (Requesting ward, unit, or activity)
DATE OF REQUEST
ENT Department
White House Medical Unit
24 January 1976
REASON FOR REQUEST (Complaints and findings)
History of right maxillary sinusitis Oct 19-25 with fever and which
responded completely to antibiotics and local treatment. He has a history
of post-nasal drip on arising each morning.
MMIL
PROVISIONAL DIAGNOSIS
DOCTOR'S SIGNATURE
APPROVED
PLACE OF CONSULTATION
EMERGENCY
Wm. m. Lukach M.D.
BEDSIDE
ON CALL
ROUTINE
RAdm, MC, USN
CONSULTATION REPORT
Physician to the President
General examination of the head and neck is within normal limits. The
larynx appeared normal. The ears, nose and pharynx are normal. There is
no evidence of residual rhinitis or sinusitis. Transillumination of the
paranasal sinuses is normal. X-rays of the sinuses are normal.
Impression: Normal head and neck and ear, nose and throat examination.
M.O.,Ine
H. 0. DE FRIES, CAPT, MC, USN
(Continued on reverse side)
SIGNATURE AND TITLE
DATE
IDENTIFICATION NO.
ORGANIZATION
PATIENT'S IDENTIFICATION (For typed or written entries give: Name-last, first,
REGISTER NO.
WARD NO.
middle; grade; date; hospital or medical facility)
Ford, President Gerald R.
S/N 0109-201-2602
CONSULTATION SHEET
The White House
Standard Form 513
372-28-6532
513-104-02
ORTHOPAEDIC CONSULTATION
President Ford has some post traumatic arthritis in both knees. He is
having no pain in either knee. His regular exercise program has resulted
in his legs feeling stronger than they have in several years which made his
recent skiing trip very satisfying and enjoyable.
3.K.Temmons
FORD it LIBRARY
Standard Form 513
Rev. August 1954
Bureau of the Budget
Circular A-32
S/N 0109-201-2602
CLINICAL RECORD
CONSULTATION SHEET
REQUEST
TO:
FROM: (Requesting ward, unit, or activity)
DATE OF REQUEST
Orthopedic Department
White House Medical Unit
24 January 1976
REASON FOR REQUEST (Complaints and findings)
Evaluation of post-operative knee condition. Swelling in left knee with
excessive activity.
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DOCTOR'S SIGNATURE on 8SW APPROVED PLACE OF CONSULTATION
EMERGENCY
Wm. m Lukash m D
BEDSIDE
ON CALL
ROUTINE
RAdm, MC, USN to does CONSULTATION REPORT to notisnimexi
Physician to the President OEI to egner S decords seergeb 2 duods to
Inminim at stedT [[u] to 01-2 Juods
по notisitions on bas semi add to motion evissaq bas svijos по
Since the President's last annual physical examination, he has followed a regular
program of quadriceps exercises. He took asprin, 600mgm Q.I.D. for about three
86
weeks. With this exercise and medication program his symptoms improved significantly.
He has not taken asprin on a regular schedule since that time, but has taken doldw
Butazolidin for short periods of time on one or two occasions when increased on
stress has resulted in an effusion. This has resulted in rapid resolution of
the effusion. In addition to the weight-lifting program, he also uses a
stationary bicycle on a daily basis. He has had no pain in the knees, and
states that he has had no episodes of catching or giving way of either knee. at
He does describe crepitation in the right knee, particularly in going down sallivo
steps. During his recent skiing trip in Colorado, his left felt strong, the
knees stable, and he sustained no injury to either knee. He does note some Intot
limitation of flexion, particularly of the right knee. The right knee, in
general tends to give him more symptoms than the left. :nolessiqmI
to no and add no asgusdo
He had a transient episode of left trapezius discomfort associated with some
stiffness of the neck. This responded rapidly to intermittent cervical
traction, ultra-sound and swimming. With swimming regularly he has had no recurrence
of these symptoms. He had no radicular pain into either upper extremity.
to
Physical examination of the right knee an apparently lack of full extension bluow
of approximately 5 degrees and he flexes through a range of 120 degrees lacking
2
(Continued on reverse side) motisolbal Off
SIGNATURE AND TITLE benotiness
DATE
IDENTIFICATION NO.
ORGANIZATION
189Y
PATIENT'S IDENTIFICATION (For typed or written entriés give: Name-last, first,
REGISTER NO.
WARD NO.
middle; grade; date; hospital or medical facility)
S/N 0109-201-2602
CONSULTATION SHEET
Ford, President Gerald R.
Standard Form 513
513-104-02
The White House
372-28-6532
myot
avos
И\8
T33Ha MOITATJUSHOO
СГИӀСУГ BECOUD
тазиозя
тазирзя RO 3TAO
(vividos 10 Jinu ,brew Anitsonper) :MORT
:OT
arei AS
HaU IsoibeM stidW
oibsqoritrO
(signibal) bas sinisiqme3) яоз ИОВАЗЯ
dliw send fisl at gaillow? .noitibnoo seal lo
.ylivitos evisseexe
approximately 15 degrees of full flexion. There is a moderate degree of
patello-femoral crepitation with active and passive motion of the knee wehi
which is not painful. Patel10-femoral compression movements also produces
a non-painful crepitation. There is a slight effusion and chronic synovial
thickening. The medial and lateral collateral ligaments are stable as are
the anterior and posterior cruciate ligaments. No rotatory instability was
demonstrated. Rotatory stress did not produce pain and there was no joint line
tenderness.
JUAD
Examination of the left knee reveals, again, an apparent lack of full extendion
of about 5 degrees, with flexion through a range of 130 degrees He lacks
about 5-10 degrees of full flexion. There is minimal patelo-femoral crepitation
on active and passive motion of the knee, and no crepitation on patello-femoral
compression manually. The medial and lateral collateral ligaments are stable
as are the anterior and posterior cruciate ligaments. No rotatory instability
was demonatrated. There is chronic synovial thickening and a šlight effusion
which is a little more than that that is present in the right knee. There was
no joint line tenderness and no pain on rotatory stress. Jrode TOT
10 molitioner bigst befluest and DB and asstta
X-ray examination of both knee demonstrate degenerative changes of the lateral
compartments of both knees, greater on the right than on the left. There
is marginal osteophytic formation on both femoral condyles, and the subchondral 893838
outline of the patella on the sunset view is quite irregular. The medial
compartments of both knees are quite well perserved as far as the width of the
joint space is concerned. redule on bentsteue ed bris
nt to notistimil
Impression: Degenerative arthritis of both knees, with more advanced x=ray
changes on the right than on the left. There is more involvement of the
lateral kcompartmants of the knees, than the medial and there is also
S
bsd
sH
involvement of the patelão-femoral articulation. adj to
on bed and viraluest djtW bas
Recommendation: Continue with the exercise program that he faithfully has Frees
to
been following. Believe that an extended course of asprin 0.6 Gms QID
would be helpful in reducing the degree of reactive, chronic synotitis.
IsolaydT
Since he functionally has been doing so well and is asymptomatic there is
to
no indication for surgery at the dpresent time. It is possible that a tibial
osteotomy might be indicated in the future-as was mentioned to him last 39UTANDI8
year by Dr. Wilson.
.on GRAW
ои язтаюзя
Josh :evily 10 boque ТИЗӀТАЯ
Ta3Ha HOITATJUBHOO
1005-105-0010
(villion) Isoibern S.K. 20 Intiqued state iobert
012 mrst byshnete
Stemmars blated insbiser9 ,brok
SO-401-810
sevoH stidW sdT
SEEd-85-STE
X-Ray Studies
There are moderate traumatic arthritic changes in both knees, slightly
more prominent on the right.
The chest, abdomen and sinus x-ray studies are normal.
works
FORD & we
PATIENT'S LAST NAME-FIRST NAME-MIDDLE NAME
REGISTER NO.
WARD NO.
Ford, President Gerald R.
AGE
SEX
The White House
(Check one)
62
M
BEDSIDE, WHEELCHAIR,
BED
X
372-28-6532
OR STRETCHER
PATIENT
AMBULATORY
EXAMINATION REQUESTED
Routine ChestX-ray
KUN
(Above space for mechanical imprinting, if used)
PERTINENT CLINICAL HISTORY, OPERATIONS, PHYSICAL FINDINGS, AND PROVISIONAL DIAGNOSIS
FILM NO.
DATE OF REQUEST 24Jan76
REQUESTED BY RAdm Wm. M. Lukash, M.D.
RADIOGRAPHIC REPORT
Chest: PA and lateral projections of the chest demonstrate the lungs to be clear
fully expanded. The heart, mediastinum and visible boney thorax are normal. There
is a slight dilitation of the aortic arch.
Impression: Normal chest.
KUB-Abdomen : Supine and upright projections of the abdomen demonstrate moderately
prominate osteoarthritic change about the L-4-5 interspace which is slightly
narrowed. To a lesser extent, degenerative change is also present about the L-3-4
interspace. The S-1 joints are normal. An 8 cm ovoid opacity is seen in the right
upper addominal quadrent on the supine projection. This is not seen on the upright
DATE OF REPORT:
SIGNATURE: (Specify location of laboratory if not part of requesting facility)
Standard Form 519-A (Rev. Aug. 1954)
Promulgated by Bureau of the Budget
Circular A - 32 (Rev.)
(NAME OF HOSPITAL OR OTHER MEDICAL FACILITY)
RADIOGRAPHIC REPORT
519-207
PATIENT'S LAST NAME-FIRST NAME-MIDDLE NAME
REGISTER NO.
WARD NO.
Ford, President Gerald R.
The White House
AGE
SEX
(Check one)
372-28-6532
62
M
BEDSIDE, WHEELCHAIR,
BED
OR STRETCHER
PATIENT
AMBULATORY
EXAMINATION REQUESTED
Routine Chest X-Ray
KUB
(Above space for mechanical imprinting, if used)
PERTINENT CLINICAL HISTORY, OPERATIONS, PHYSICAL FINDINGS, AND PROVISIONAL DIAGNOSIS
FILM NO.
DATE OF REQUEST 24 Jan 76
REQUESTED BY RADM WM. M. LUKASH, MC, USN
RADIOGRAPHIC REPORT
(Continued)
projection and probably represents a normal gall bladder shadow. The bowel gas
pattern is normal. There are no abnormal abdominal calcifications. The
renal and psoas muscle outlines are normal where visualized.
croochs
C. W. OCHS, CAPT, MC, USN
DATE OF REPORT:
SIGNATURE: (Specify location of laboratory if not part of requesting facility)
Standard Form 519-A (Rev. Aug. 1954)
Promulgated by Bureau of the Budget
Circular A- 32 (Rev.)
(NAME OF HOSPITAL OR OTHER MEDICAL FACILITY)
RADIOGRAPHIC REPORT
519-207
PATIENT'S LAST NAME-FIRST NAME-MIDDLE NAME
REGISTER NO.
WARD.NO.
AGE
SEX
(Check one)
Ford, President Gerald R.
62
M
BEDSIDE, WHEELCHAIR,
BED
The White House
OR STRETCHER
PATIENT
X
AMBULATORY
EXAMINATION REQUESTED
372-28-6532
Sinus series; both knees; C-spine
(Above space for mechanical imprinting, if used)
PERTINENT CLINICAL HISTORY, OPERATIONS, PHYSICAL FINDINGS, AND PROVISIONAL DIAGNOSIS
History of right maxillary sinusitis
Cartilage surgery, left knee 1929; right knee, 1972
FILM NO.
DATE OF REQUEST 24 Jan 76
REQUESTED BY RADM WM. M. LUKASH, MC, USN
RADIOGRAPHIC REPORT
Paranasal Sinuses: The sinuses are clear with no evidence to suggest sinusitis.
There is no residual mucosal thickening from the previous inflamatory epidode.
Impression: Normal Sinuses.
Knees: Moderately prominent hypertrophic degemarative osseous exchange is present
about the tibial plateaus and gliding suffaces of the patellaw. The degenerative
change is more evident on the right where there is also significant loss of the
joint space about the lateral femeral condyle. The degenerative change has
progressed slightly when compared with the previous study obtained 7-8-72. There
is no evidence of loos bodies in the joint spaces. Of particular note is the
DATE OF REPORT:
SIGNATURE: (Specify location of laboratory if not part of requesting facility)
Standard Form 519-A (Rev. Aug. 1954)
Promulgated by Bureau of the Budget
Circular A- 32 (Rev.)
(NAME OF HOSPITAL OR OTHER MEDICAL FACILITY)
RADIOGRAPHIC REPORT
519-207
PATIENT'S LAST NAME-FIRST NAME-MIDDLE NAME
REGISTER NO.
WARD NO.
AGE
SEX
(Check one)
BEDSIDE, WHEELCHAIR,
BED
OR STRETCHER
PATIENT
AMBULATORY
EXAMINATION REQUESTED
(Above space for mechanical imprinting, if used)
PERTINENT CLINICAL HISTORY, OPERATIONS, PHYSICAL FINDINGS, AND PROVISIONAL DIAGNOSIS
FILM NO.
DATE OF REQUEST
REQUESTED BY
RADIOGRAPHIC REPORT
(Continued)
finding of significant hyperostosis about the anterior medial surface of the medial
femeral condyles and roughening with hyperostoses about the posterior medial surface
of the lateral femeral condyles.
Impression: Osteoarthritis, more prominent on the right.
Cervical spine: AP and lateral projections of the cervical spine slemonstrate
moderately prominent hypertrophic degemerative osseous change about the C-5-6
interspace with associated narrowing of the interspace. There is a moderate
DATE OF REPORT:
SIGNATURE: (Specify location of laboratory if not part of requesting facility)
Standard Form 519-A (Rev. Aug. 1954)
Promulgated by Bureau of the Budget
Circular A - 32 (Rev.)
(NAME OF HOSPITAL OR OTHER MEDICAL FACILITY)
RADIOGRAPHIC REPORT
519-207
PATIENT'S LAST NAME-FIRST NAME-MIDDLE NAME
REGISTER NO.
WARD NO.
AGE
SEX
(Check one)
BEDSIDE, WHEELCHAIR,
BED
OR STRETCHER
PATIENT
AMBULATORY
EXAMINATION REQUESTED
(Above space for mechanical imprinting, if used)
PERTINENT CLINICAL HISTORY, OPERATIONS, PHYSICAL FINDINGS, AND PROVISIONAL DIAGNOSIS
FILM NO.
DATE OF REQUEST
REQUESTED BY
RADIOGRAPHIC REPORT
(Continued)
encroachment on the spinal canal by posterior spur formation. The remaining portions
of the cervical spine are normal. There are no structural defects.
Impression: Osteoarthritis about the C-5-6 level.
works
C. W. OCHS, CAPT, MC, USN
DATE OF REPORT:
SIGNATURE: (Specify location of laboratory if not part of requesting facility)
Standard Form 519-A (Rev. Aug. 1954)
Promulgated by Bureau of the Budget
Circular A- 32 (Rev.)
(NAME OF HOSPITAL OR OTHER MEDICAL FACILITY)
RADIOGRAPHIC REPORT
519-207
Standard Form 519
Rev. August 1954
Bureau of the
U.S. Government 0-0 Printing Office: 1974 0 - - 534-878
Budget Circular A-32
CLINICAL RECORD
RADIOGRAPHIC REPORTS
ATTACH 3D REPORT ALONG HERE
AND SUCCEEDING ONES ON ABOVE LINES
ATTACH 2D REPORT WITH TOP AT THIS LINE
ATTACH IST REPORT ALONG LEFT MARGIN WITH TOP AT THIS LINE
ATTACHING MARGIN
PATIENT'S IDENTIFICATION (F r typed or written entries give: Name-last, first, middle;
REGISTER NO.
WARD NO.
grade: date; hospital or medical facility)
RADIOGRAPHIC REPORTS
FORD, President Gerald R.
Standard Form 519
372-28-6532
519-106
Standard Form 513
Rev. August 1954
Bureau of the Budget
Circular A-32
S/N 0105-LF-201-2602
CLINICAL RECORD
CONSULTATION SHEET
REQUEST
TO:
FROM: (Requesting ward, unit, or activity)
DATE OF REQUEST
Laboratory
White House Medical Unit
24 January 1976
REASON FOR REQUEST (Complaints and findings)
Lipoprotein Profile
PROVISIONAL DIAGNOSIS
DOCTOR'S SIGNATURE
APPROVED
PLACE OF CONSULTATION
EMERGENCY
BEDSIDE
ON CALL
ROUTINE
RAMM, MC, USN
CONSULTATION REPORT
Physician to the President
The study of the President's blood lipids reveal no abnormalities.
(Continued on reverse side)
DATE
IDENTIFICATION NO.
SIGNATURE Nhaha AND TITLE CAPT mc USN
ORGANIZATION
24 JAN 76
NNMC
PATIENT'S IDENTIFICATION (For typed or written entries give: Name-last, first,
REGISTER NO.
WARD NO.
middle; grade; date; hospital or medical facility)
FORD, President Gerald R.
S/N 0105-LF-201-2602 CONSULTATION SHEET
372-28-6532
Standard Form 513
513-104-02
Standard Form 513
Rev. August 1954
Bureau of the Budget
Circular A-32
S/N 0109-201-2602
CLINICAL RECORD
CONSULTATION SHEET
REQUEST
TO:
FROM: (Requesting ward, unit, or activity)
DATE OF REQUEST
Laboratory
White House Medical Unit
24 January 1976
REASON FOR REQUEST (Complaints and findings)
Lipoprotein Profile
PROVISIONAL DIAGNOSIS
DOCTOR'S SIGNATURE
APPROVED
PLACE OF CONSULTATION
EMERGENCY
Wm. m. Lukaeh,M.D.
BEDSIDE
ON CALL
ROUTINE
RAdm, MC, USN
CONSULTATION REPORT
Physician to the President
Serum clear
is
Triglycerides: 115 mg %
45
Cholesterol: 275 mg %
200
Lipoprotein Phenotype Normal
(Continued on reverse side)
SIGNATURE AND TITLE
DATE
IDENTIFICATION NO.
ORGANIZATION
Mall CAPT MC USN
24 JAN76
NNMC
PATIENT'S IDENTIFICATION (For typed or written entries give: Name-last, first,
REGISTER NO.
WARD NO.
middle; grade; date; hospital or medical facility)
S/N 0109-201-2602
Ford, President Gerald R.
CONSULTATION SHEET
Standard Form 513
372-28-6532
513-104-02
PATIENT CUMULATIVE REPORT
111111 FORD, GERALD R.
00 372 28 6532 OUT
1/24/76
DATE
1/24
TEST
NORMALS UNITS
STAT UA
URINE
(0732)
COLOR
YELLOW
APPEARNC
CLEAR
SPC GRAV
1.018
BLOOD
NEG
KETONES
NEG
GLUCOSE
NEG
PROTEIN
NEG
PH
5.0
RBC'S
/HPF
RARE
WBC'S
/HPF
RARE
EPI'S
/HPF
OCC
CBC STAT
BLOOD
(0734)
WBC
5.0- 10.0 K/CMM
5.3
RBC
4.7-
6.1 M/CMM
4.67*
HGB
14.0- 18.0 GM% 15.2
HCT
42.0- 52.0 VOL% 45.2
MCV
80.0- 94.0 CMI 94.
MCH
27.0- 31.0 MMG 31.9 #
MCHC
32.0- 36.0
% 33.9
DIFF STAT
BLOOD
(0734)
SEG
51.0- 67.0
% 36. *
LYMPH
21.0- 35.0
% 57. #
MONO
4.0-
8.0
%
6.
BASO
.0-
2.0
%
1.
EOSIN
2.0-
4.0
%
0. #
PLATELTS
ADEQ
ATYP LYM
OCC
BLOOD TYPE
BLOOD
(0951)
RESULT
0 POS
COOMBS INDIR
BLOOD
(0951)
RESULT
NEG
TEMPORARY REPORT - DISCARD WHEN NEXT REPORT IS RECEIVED
111111 FORD, GERALD R.
00 372 28 6532 OUT
1/24/76
PATIENT CUMULATIVE REPORT
111111 FORD, GERALD R.
00 372 28 6532 OUT
1/24/7
DATE
1/24
TEST
NORMALS UNITS
SMA-12
BLOOD
(0734)
TOT PROT
6.0-
8.0
GM%
6.2
ALBUMIN
3.5-
5.0
GM%
4.2
CALCIUM
8.5-
10.5
MG%
8.9
PHOS
2.5-
4.5
MG%
3.0
CHOLEST
150.0-300.0
MG%
276.
BUN
10.0- 20.0
MG%
14.
URIC AC
2.5-
8.0
MG%
7.4
CREATNIN
.6-
1.4
MG%
1.4
TOT BILI
.2-
1.0
MG%
.6
ALK PHOS 30.0- 85.0 MU/ML 50.
LDH
100.0-225.0 MU/ML 159.
SGOT
7.0- 40.0 MU/ML 25.
SMA-6
BLOOD
(0734)
CHLORIDE
95.0-105.0 MEQ/L
104.
C02
24.0- 32.0 MEQ/L 29.1
POTASIUM 3.5- 5.0 MEQ/L 4.8
SODIUM
135.0-145.0 MEQ/L 143.
BUN
10.0- 20.0 MG% 14.
GLUCOSE 65.0-110.0 MG% 142.
so
CPK
BLOOD
(0734)
RESULT
30.0-110.0TU/L
46.
LDH
BLOOD
(0734)
RESULT
50.0-115.0IU/L
90.
SGOT
BLOOD
(0734)
RESULT
5.0- 25.0IU/L
9.
SGPT
BLOOD
(0734)
RESULT
5.0- 30.0IU/L
7.
GLUCOSE
BLOOD
(0734)
GLUCOSE
65.0-100.0MG%
112. #
LIPIDS
BLOOD
(0734)
CHOLEST
MG%
275.
TRIGLYC
MG% 115.
300 174 } upper limits
MONO
BLOOD
(1001)
RESULT
NEGATIVE
111111 FORD, GERALD R.
00 372 28 6532 OUT
1/24/76
Standard Form 514
Rev. August 1954
Bureau of the Budget
Circular A-32 (Rev.)
CLINICAL RECORD
LABORATORY REPORTS
Ford, President Gerald R.
Callud
SPECIMEN 26 RPT. NO.
The White House
BIOLOGY
372-28-6532
002989
PATIENT
STATUS
ADMITTED vy
INFECTION
BED
HOSPITALACQUIRED
AMB
PRE-OPERATIVE
POST-OPERATIVE
x
OUT PT.
NON GICAL
DOM
TPARTUM
Enter in above space:
REQUESTING PHYSICIAN'S SIGNATURE
PATIENT IDENTIFICATION-TREATING FACILITY-WARD NO.-DATE
IN
NEWBORN
NP
OTHER (Specify)
REPORTED BY
Wm. M. Lukash, M.D.
DATE
LAB ID. NO.
MD
CLINICAL INFORMATION (Include Specimen Source)
TECH
2 JAN 76 08
JAN
56
ACTERIAL THERAPY
1976
ATTACHING MARGIN
A.M.
P.M.
LABORATORY DEPARTMENT
NAVMEOSCHOL, NNMC
SPECIMEN TAKEN
0800
CULTURE
COLONY COUNT
BETHESDA. MARY AND 20014
TIME
EXAMINATION REQUESTED
X
X
PREDOMINANT ORGANISM(S)
SENSITIVITY
COLONY COUNT
12,000 /ML
NNE.
MICROBIOLOGY
DATE
1-24-76
SMEAR
SENSITIVITY
REPORT:
Standard Form 553 (July 1971)-GSA FPMR 101-11.8
X
MIXED FLORA
1.
2.
SPE
1/24/
RESULTS
142
71
143
4.5
DATE
104
"be
blu
e11
STAIN
SPEC
1/24/
RESULTS
15.2
2 45.2
5.3
36
57
/
9
Star
DATE
NO
SPEC
1/24/
RESULTS
fill
1.4
7.4
3.0
8.9
6.2
2
4.2
50.
DATE
25.
15%
0.6
276,
115
STANDARD
T
SPECIM
PATIENT
DATE
1/24/
RESULTS
Yellow
1.018
5.0
N°9
Neg
Neg
Nea
Karl
Ran
Occ
PLATE NO. 14752
LABORATORY REPORTS
FORD, President Gerald R.
Standard Form 514
514-104
372-28-6532
Stock No. 0109-201-2701
called BIOLOGY I
SPECIMEN/I RPT. NO.
Ford, President Gerald R.
MICRO-
The White House
PATIENT
002989
ADMITTED vz WITH
INFECTION
STATUS
372-28-6532
BED
HOSPITAL ACQUIRED
PRE-OPERATIVE
AMB.
POST-OPERATIVE
X
OUT PT.
NON-SURGICAL
DOM.
VD
POSTPARTUM
NEWBORN
IN
NP
OTHER (Specify)
Enter in above space:
PATIENT IDENTIFICATION-TREATING FACILITY-WARD NO.-DATE
REQUESTING PHYSICIAN'S SIGNATURE
REPORTED BY
DATE
LAB ID. NO.
MD
Wm. M. Lukash, M.D.
TECH
JAN
1976
CLINICAL INFORMATION (Include Specimen Source)
2 JAN 76 08 56
BACTERIAL THERAPY
CLUIC
LABORATORY DEPARTMENT
NAVMEUSCHOL. NNMC
A.M.
P.M.
BETHESDA. MARYL AND 20014
SPECIMEN TAKEN
TIME
0800
EXAMINATION REQUESTED
CULTURE
COLONY COUNT
X
PREDOMINANT ORGANISM(S)
COLONY COUNT
NAVREGRED
SENSITIVITY
12,000 /ML
NAVOEPT
X
MICROBIOLDGY -
RINE.
SMEAR
SENSITIVITY
Standard Form 553 (July 1971)-GSA FPMR 101-11.8
DATE
1-24-76
X
REPORT:
MIXED FLORA
1.
2.
SPECIMEN/LAB. RPT. NO.
CHEM I
Ford, President Gerald R.
URGENCY
PATIENT STATUS
The White House
BED
AMB.
372-28-6532
ROUTINE
OUTPATIENT
X
TODAY
NP
DOM.
SPECIMEN SOURCE
PRE-OP
X
BLOOD
STAT
X
OTHER (specify)
Enter in above space: PATIENT IDENTIFICATION - TREATING FACILITY- WARD NO. - DATE
REQUESTING PHYSICIAN'S SIGNATURE
REPORTED BY
PAP
MD
DATE
1/24/76
LAB. ID. NO.
Wm. M. Lukash, M.D.
TECH
REMARKS
Chloude 104,
Potassum 4.8
Glucose 142,
Sodium 143.
CO2 29.1
BUN 14,
AUTOMATED
METHOD
8
MANUAL
A.M.
1/24/76 0800
REQUESTED
TEST($)
GLUCOSE
UREA N.
CREATININE
URIC ACID
wnidos
POTASSIUM
CHLORIDE
PROFILE (specify)
SMA-6
CHEMISTRY -
co2
PHOSPHATE
CALCIUM
TOTAL
PROTEIN
ALBUMIN
GLOBULIN
PHOSPHATASE
ALKALINE
PHOSPHA-
TASE-ACID
SGOT
LDH
CPK
BILIRUBIN
(TOTAL)
BILIRUBIN
(DIRECT)
CHOLESTEROL
TRIGLYCERIDES
BSP
AMYLASE
LIPASE
SPECIMEN TAKEN
TIME
(X)
X
STANDARD FORM 546 (JULY 1971)-GSA FPMR 110-11.8
RESULTS
142,
14.
143.
4.8
104,
l'be
DATE
blue
112
SPECIMEN/LAB. RPT. NO.
HEMA-
Ford, President Gerald R.
TOLOGY
The White House
URGENCY
PATIENT STATUS
ROUTINE
BED
AMB.
372-28-6532
OUTPATIENT
X
TODAY
NP
DOM.
PRE-OP
SPECIMEN SOURCE
X
VEIN
CAP
STAT
x
OTHER (Specify)
Enter in above space:
PATIENT IDENTIFICATION-TREATING FACILITY-WARD NO.-DATE
REQUESTING PHYSICIAN'S SIGNATURE
REPORTED BY
MD
MD
DATE
LAB. ID. NO.
Wm. M. Lukash, M.D.
TECH
1/24/10
REMARKS:
occ. ATL
AUTO-
METHOD
(X)
MATED
MANUAL
REQUESTED
RBC COUNT
WBC COUNT
NEUTRO-
BANDS
NEUTRO-
SEGS.
LYMPHO-
CYTE
EOSINO-
PHILS
BASO-
PHILS
MONO-
CYTES
PLATELETS
RBC
HGB
HCT
PLATELET
RETICULO-
CYTE COUNT
CLOTTING
BLEEDING
CONTROL
PATIENT
PATIENT
ACTIVITY
HEMATOLOGY
DATE 1/24/76 TIME 0800
IMMATURE
SED. RATE
CONTROL
COUNT
RATIO
TEST(S)
%
SPECIMEN TAKEN
TIME
TIME
SICKLING
I I F E E D F R T N L A
P
P
TEST
LE PREP
T
T
RO
ME
EWInwon)
MCV
MCH
MCHC
Standard Form 549 (July 1971) 1971)-GSA GSA FPMR 11.8 101-11.8
(x)
X
X
X
RESULTS
15.2
45.2
5.3
36
57
/
9
Adaq.
SPECIMEN/LAB. RPT. NO.
Ford, President Gerald R.
CHEM I
URGENCY
PATIENT STATUS
The White House
BED
AMB.
372-28-6532
ROUTINE
OUTPATIENT
X
NP
DOM.
TODAY
SPECIMEN SOURCE
PRE-OP
X
BLOOD
STAT
OTHER (specify)
X
Enter in above space: PATIENT IDENTIFICATION - TREATING FACILITY- WARD NO. - DATE
REQUESTING PHYSICIAN'S SIGNATURE
REPORTED BY
KAP
MD
DATE
LAB. ID. NO.
Wm. M. Lukash, M.D.
TECH
1/24/76
REMARKS
AUTOMATED
METHOD
(x)
MANUAL
A.M.
TEST(S)
1/24/76 0800
REQUESTED
GLUCOSE
UREA N N.
CREATININE
URIC ACID
SODIUM
POTASSIUM
CHLORIDE
co2
PHOSPHATE
CALCIUM
TOTAL
PROTEIN
ALBUMIN
GLOBULIN
PHOSPHATASE
ALKALINE
PHOSPHA-
TASE-ACID
SGOT
LDH
CPK
BILIRUBIN
(TOTAL)
BILIRUBIN
(DIRECT)
CHOLESTEROL
TRIGLYCERIDES
PROFILE (specify)
SMA-12
Lipids
CHEMISTRY -
BSP
AMYLASE
LIPASE
SPECIMEN TAKEN
TIME
(X)
X
X
STANDARD FORM 546 (JULY 1971)-GSA FPMR 110-11.8
RESULTS
fill
1.4
7.4
3.0
8.9
6.2
4.2
50.
25,
159
0.6
276,
115.
DATE
SPECIMEN/LAB. RPT. NO.
URIN-
ALYSIS
Ford, President Gerald R.
URGENCY
PATIENT STATUS
The White House
BED
AMB.
ROUTINE
372-28-6532
OUTPATIENT
X
NP
DOM.
TODAY
SPECIMEN SOURCE
PRE-OP
Tabortons
x
ROUTINE
STAT
X
OTHER (Specify)
Enter in above space:
PATIENT IDENTIFICATION-TREATING FACILITY-WARD NO.-DATE
REQUESTING PHYSICIAN'S SIGNATURE
REPORTED BY
MAR
MD
DATE
Wm. M. Lukash, M.D.
TECH
1/24/76
LAB. ID. NO.
REMARKS:
P.M.
REQUESTED
Clear
1/24/76 0800
ROUTINE
MICROSCOPIC
GRANULAR
BILINOGEN
BENCE-JONES
HEMOSIDERIN
URINALYSIS
EPI CELLS
WBC
RBC
HYALINE
TEST(S)
TIME
X
COLOR
SPECIFIC
GRAVITY
GLUCOSE
PROTEIN
OCCULT
BLOOD
KETONES
BACTERIA
CRYSTALS
BILE
PROTEIN
SPECIMEN TAKEN
URO.
PSP
HCG
(x)
pH
X
WBC
RBC
MUCUS
15 MIN,
Standard Form 550 (July 1971) (July1971)-GSA GSA FPMR 101-11.8 11.8
C
V
S
1
- HR.
S
DATE
RESULTS
Yellow
1.018
5.0
Nog
Neg
Neg
Neg
Kare
Rane
Occ
Standard Form 514
Rev. August 1954
Bureau of the Budget
Circular A-32 (Rev.)
CLINICAL RECORD
LABORATORY REPORTS
ATTACH 3D REPORT ALONG HERE
AND SUCCEEDING ONES ON ABOVE LINES
ATTACH 2D REPORT WITH TOP AT THIS LINE
ATTACH 1ST REPORT ALONG LEFT MARGIN WITH TOP AT THIS LINE
ATTACHING MARGIN
ATTACH ALL TEST REPORTS TO THIS SHEET
PATIENT'S IDENTIFICATION (For typed or written entries give: Name-last, first,
REGISTER NO.
WARD NO.
middle; grade; date; hospital or medical facility)
PLATE NO. 14752
LABORATORY REPORTS
FORD, President Gerald R.
Standard Form 514
514-104
372-28-6532
Stock No. 0109-201-2701