on SALE VY Cereus Work steer THIS WORK SHEET SHOULD BE RETAINED BY THE MAKER OF THE CERTIFICATE FOR REFERENCE PURPOSES23147 OFFICE OF THE MEDICAL EXAMINER COUNTY OF COOK, ILLINOIS RESULTS OF TOXICOLOGIC ANALYSES PATHOLOGIST oy. Lifechsles PECEASED_ndam Janus _ MED. EXAM, CASE. No,__652 September 1962 ___TOKICOLOGY CASE NO._s243147 DATE MATERIAL RECEIVED ALCOHOL: BARBITURATES: ‘carson nowox2De: orrames: ccenape ‘mrocvanare, PROPONYPHENE. [BENZODIAZEPINE Netiapow AACEYRUTHOPHEN poe So URINE, [NEGATIVE (9 wegarrve > ) MEGaPrvE () meoarrve 0) necanrve ©) meoaerve POSTTEvE, 1982 DATE OP REPORT_January 7, 1983 Posrmve___ nO, POSITIVE, POSITIVE! POSITIVE 'S SATURATION HEMOGLOBIN oO () Noniaz (cess THAN 108) oO CO wecanrve (00 weGarrve () wegxerve () wwoartve () mecarrve () wpcanrvE ) wecamzve > mecareve ) NEGATIVE 2) NEGATIVE (0) NEGATIVE ) NEGATIVE 9) NEORTIVE O) mecarrve C) NEGATIVE () posrrrve, () Postmave, () Postmive, () posrerve, () Positive () postnra () poster (q) Posterve 37 wicroarana/al 0) postarve 15.7 mas () postmive, ‘ ) } posrrrve ) posrTve) ) Postave! (x) Posrazva “Tid wiseogransjal (2) positive —23¢-mtersaeans at ———— nishaot 1, sanaceerehb. O07 oxtcoosist yrsSept. 82 MEDICA BXAMIVER CASE REPORT COOK COUNTY CASE NO. 652 TECERSE ‘RGE-] SEX] HACE ADDRESS ivLington Wes. PACH ‘Adam Jamis 27 | Mu wo | 12qmp. mitchei "593-2299 CLASSIFICATION [EPS OF INVESTIGATION MATA eee }CENE__TELEPHONE_x F.H.__HOSP,_ [DORESS-OF OUCIRENTE EPSOF PREMISES” WHERE-FOUM: Northwest Community | Hospitan TOE/DATE FOUN Piouk Lito Me FOSTOE ROENCY FT Sept.29, 1982 PERSON DISCOVERING DECEASED —] HELATIONSHIF DURES! PHONE PERSON INTERVIEWED Marian Czyz Inge Brigtsen Bu p PRONOUNCED TOCKTN | Sept. 29, 1982 3215 PM | | | Northwest Commnity Hospital, ARRIVAL SCENE, 9/29/82 i POLIGE NOT: 0 PM WERRATIVET —UISCRTEE CIRUUNSTANCES SURROUNDING DERTH-FRYSIONL EVIDENCE R/T assigned this telephone investigation at 4210 PM Sept. 29, 1982. R/T learned through @ telephone interview with nurse Brigsten that the subject was complaining of pain in the left neck and chest area, this occurred on Sept. 28, 1982. Whon the subject awoke on Sept.29, 1982’ the pains had subsided, but he stated he still did not feel well. Subject came home for lunch and laid down for awhile, his wife tried to awake him out to no avail, The Arlington Hts. F.D, transported the subject to Northwest Community Hospital were he was admitted. Subject was adnitted at 2:33 PM with an A/D of Rule out M.I, versus Subarachnoid Henorrhage. Subject was pronounced at 3:15 PM by Dr. Kin. Mr. Gays (brother-in-law) stated thet the subject was in apparent good health. Remains along with the medical records were ordered to the institue for further investigation.roar 6s seo mune WORK sHeer MEDICAL EXAMINER'S CERTIFICATE OF DEATH pedo i i zap [ THIS WORK SHEET SHOULD BE RETAINED BY THE MAKER OF THE CERTIFICATE FOR REFERENCE PURPOSESMEDICAL CERTIFICATE OF DEATH WORK SHEET