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Page 1184 Description of course of iliness (past and present) and cause of the death in sufficient detail to indicate circumstances of death, including treatment, medications, diagnostic testing, etc. Give findings of diagnostic exams. Insert pages in this section as required. Intake Screening History and Physical present? Date of most recent History and Physical Timeliness of Diagnostic and Treatment regimes? Discharge summary from Attending M.D. on chart Institution Community Hospital Autopsy Toxicology Death Certificate Available INSTITUTION MEDICAL CARE REVIEW: Severity of illness at time of admission to hospital / Health Services Unit Prognosis on admission to hospital / health Services Unit Were diagnostic procedures appropriate and timely Was treatment appropriate to diagnosis and instituted timely Prognosis with treatment Any complications adversely affecting outcome: Describe briefly _Asphyxiation Secondary to Hanging. Was treatment appropriate to complication Surgical Procedures (list) Appropriate pre-operative evaluation completed, including lab, physical exam, updated history Complications related to surgical procedures (describe) Prognosis following surgical procedure Patient compliant with treatment / medications PDF Prescribed by P6013 _v¥_Yes __No ___NA _ 07/09/2019 _¥_Yes —___No __NA Yes _¥_No —__NA —_—Yes _¥_No __NA Yes ¥ No __NA ___Yes vY_No __NA ___Yes _¥_No __NA ___ Critical. _¥ Stable — Unknown Poor _¥_ Good — — NA _y¥_Yes ___No v¥_Yes No — Poor -¥— Good —_ Unknown ___ Yes _¥_No _v¥_Yes ___No Yes No ¥_NA ! Yes No ¥_NA ___Yes ___No _y¥_NA _—. Poor —— Good _y¥_ Unknown Yes No _v¥_NA 3 DOJ-OGR- 00025389