(2)
Block 2.
(a) Enter patient's unit of assignment and the country of whose armed
forces the patient is a member.
(b) Check armed service of the patient (e.g., A/T = Army, AF/A = Air
Force, N/M = Navy, and MC/M = Marines).
(3)
Block 3.
(a) Use Figures to show location of injury or injuries.
(b) Check appropriate box( es) to describe patient injury or injuries.
(4)
Block 4.
Check appropiate box.
(5)
Block 5.
Write in the pulse rate and the time that the pulse was measured.
(6)
Block 6.
(a) Check yes or no box.
(b) Write in date and time that tourniquet was applied.
(7)
Block 7.
(a) Check yes or no box.
(b) Write in d ose administered.
(c) Write in date and time administered.
(8)
Block 8.
(a) Write in type of solution.
(b) Write in time and location given.
NOTE: If additional space is required, use Block 9.
MD0751
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