Transcript of 166-12c-1_serial_1_section_3_56-la-156_la_report_6.9.68-part_2_of_6.pdf

================================================== Page 1 ================================================== 3osu VST iele;kone Si;kir} 5-03: A; 5, Csle CcCTOJSnSZDC0Wo Ii? Immeliciely after iirsl emninalicn, ": u: cow] &irectlj 10 th#: Disin 0/' i.ixr Sulisli:s &l Reserh P.0. IBux 965, sn Fenisco 1 snd] r"c to Entcrprise Irs_iCc (:i #l cincs} sow aoa Kilwra {0 iile # rpor wrh &e Division is J miseemeno:. (Labo: Cuae, Section 6i07-6+113.) Acswer _ eGliors fej; 1o 7: 8 2: 1 EiOrEr 2 feJress (N% (X=n: 20,Suildiss cofs 3 BusrS sruchon_ 3c 2w$cloi cc. EMPLOVEE 'EZE =d 32123 5_ Address (N%aiS; Te.No. 6. Occ-patioz : 7_ Date injured Hour_ Date Jest wo-ked_ iYo S:_ 8 Injered at 8y) Ecuzty- 9. Date of your firz: exemiczticn: _ Hcur M Who engaged ycur services? 10. Name other Zcccrs who tezted erpoyc? for this injury: 11. ACCDENT O_ EXPOSURE: Did eployee notify ercployez of tls injury? Emplcyee'$ stemest c.f czuse of injery o iLzess: { 620?%3Xc? 12. NATUEE AND EZTZNz 0j INJUZY O2 IZSZAZE (Include all objective fndicgs, subjcctive ccmplaints, 222 Zi-gcocs Ioccuprtionil Ciseuse Stare &ete 0f onset, Occupationai his:o:7, 228 zposures ) 0X 83 140 {8,9): 3b 303 69; 2, i. X Z020 G 13_ I-IC7:: 3] Fic_ tskcz? (Sczfe #: aoce)-S_ Fijd-%: 14 Errrt: : V 15. %coc0 836,856 horpielizcd, cete Fster Nar: #d 1d-233 8f hosinl 16. Furertzi_tren: (37ue 46 cu:a:o: rzeerCi 17. Estizated 02 d.sabilty for: Regler woz: Nodined wor 18. Dcscrbe E57 Zernaert discbility Or dishgureraent exnected (Stare if ncze) _ 19. Ii dezti cGszed, sive Zate 20. JEN:RLS {Nc:: 137 prc-ceis;ing icjurics CI disenses, ceed for szedi-l exazication Or Icbc-aiory tcs:S, ciher per:ces: :nfore_cc (I1z: O: Zc:) (No S:_ Datco r? fddress E Cizi)" FiRX CL JG 11-61 7.? Uss #3*s2 se:ore :p:su 72"t22 copies 2erca 669 ================================================== Page 2 ================================================== S T A 1 : M % N T MINT Sim:n SIXIIAN DILL To moom No. MospitaL NO_ Ei-k179 Juness 626 1 Exard AODRESS Out-Patient DATE ADM. IX Pasadcn:l , Californlia city RATE IOUR ADM_ 10 8_56 #ONE PHONE DoctOR? Schnepper DATE DISCH_ HR.0iscit. orrriting O4LY DFUGS ulomton?y #{d. Sufg_ SuP_ OR DELIVERY X-RAY TFLEviSiON MISCELLANEOUS YOuR BALAINCE {CSFitAl Tor Tife Adm MMEREOF cRvice KENTAL RECEIPT DATE CFEDITS Serce NUMBER PAY Ust Wouxt AuuNT CODE AMOuNT COOE AMOUNT A#iOUNT CODE AMOuNT AMOUNT CODE AMOUNT 5.0 0 83 OcT 11 65 5,0 0 SELF 51 OCT { 2 6 5,0 0 8 34 SEz REVERSE SIDE: OF YOUR STATEMENTS_ BILLING AGENT FOR 'ODES Ai2 TAXEN FRCM TNE 064 RELATIVE VALUE STUDIES 4Th EDITION. CORONA C 0MMUNitV HospiA L PAUL H; DcEB. M.D_ Jomn w Kizziaa_ M,D. D,TE Of Posti;:g DOES NoT YOUR PKiVATE PhYSiCMN'S CON- 812 SO. WASHBURN: AVENUE CORONA, CALIFORNIA RADIOLOGIsTs ECESSARilY RepR esENT TiE DATE SULTANT'S AND ANESTN-ESIOLO- He SeRVICE #IRS RENDERED_ Gists CHARGES Arre Not IN- TELEPHONES: 737-4343 688-0093 thioms E_ Jorits. M.o_ CLUOED iN THIS BILL PAtifologisr ThIS Miil INCLUDES ALL CHIARGES RE- PORTEU) To TMis CFFICE Urp To TIME OF Dischangf_ :JNREPORTED CMARGES WIll ALL Bills PAYABLE ON PRESENTATiON PATIENT'S STATEMENT if #ILLEO LTER, WILLs -PAYAOLE Upon RETAIN FOR INSURANCE AND TAX RECORDS_ PrESENTATION. ================================================== Page 3 ================================================== 5 T 4 TEM#NT AXTIENT SZnzian IC?_ SIXHIAN GILL To Industrial Aecidcil: Room No, 235-1 KospitAl No. 7983 6 AdlfESs 625 Eos: Inward ADDRESS DATE ADM 9-25-66 city Pasaden?, 8 liioria city RATE 839.00 KOUR ADM_ 12:30 Dm FHONE 7 PHONE DoCTOR 813-2136 R. Nclscn DATE Disch; HR. DISCH. OAILY DRUGS UBORATORY #ed. & Surg, SuP_ On DELTVERY X-RAY TELEVISION MISCELLANEOUS YOUR BALANCE HosPAL For TKc 1dM _ Thereof SErvice RENTAL RECEIPT DATE CREDITS SERVICE NUMBER PAY UsT MOUNT MmOUNT CODE AMOUNT CODE AMOUNT AMoyNT CODE AMOUNT AmounT CODE AMOUNT SF 26 € 39.00 3.35 6.00 8,628 4.40 5,00 8874 3,50 /936 4 75 30 5,0 SUTURE 1,0 PAEP TRh 1750 /,307 25.00 /,026 15.00 /,248 1250 2,259 5,00 /,475 15,00 I MP26 [ 158,60 ARACNAU 11,754 Nov ! 9 6 158.60 .00 [Z@ SEE REVERSE SIDE OF YOUR STATEMENTS BILLING IGENT FOR CODES ARE TAKEN FROM THE 1964 RELATIVE VALUE STUDIES 4th Edition_ CORONA CoM MUNiTY MOspitA L PAUL !I_ deeB_ M.d Johin I_ KIZZiAR_ M.0 DATE OF Posting DOES Not YouR PRIVATE PHYSICIAN'S CON- 812 SO. WASHBURN AVENUE CORONA, CALIFORNIA RAdiologists NECESSARILY REPRESENT THE DATE SULTANT= S AND ANESTHESiOLO- THE SERVICE WAS RENDERED Gist's CHARGES ARE NOT IN- TELEPHONES: 737-4343 688-0093 TMOMAS E JONES_ M,d. CLUDED IN ThIS DILL PaTkologist Tkis BILL INCLUDES ALL CHARGES RE- PORTED To ThIS OFFICE UP TIME OF DISCHARGE UNREPORTED CHARGES WILL ALL BILLS PAYABLE ON PRESENTATION BE BILLED LTER. BILLS PAYABLE UPON RETAIN FoR INSURANCE AND TAX RECORDS. PRESENTATION INSURANCE COPY 8 To ================================================== Page 4 ================================================== FD-3 02 (Rev. 4-15-64 ) FEDERAL BUREAU OF INVESTIGA TION 1 Date 6/7/68 TRULA MERRIMAN Stenographer California Horse Racing Board_ 9 205 South Broadway , furnished the following: She made available an application for license a8 a hot walker completed by SIRHAN BISHARA S IRHAN - The license was issued on January 1, 1966, at the Santa Anita, California Race Track The application indicated that SIRHAN BISHARA SIRHAN_ 696 East Howard Street, Pagadena, California, was born on in Jerusalem, Jordan His employer PII was listed as GORDON BOWSHER _ A previous employer of SIRHAN was listed as CLARENCE COPPING 2529 Foothill, Pasadena 9 California Three names were listed on the form a8 persons who have Imown SIRHAN well for the past ten years _ These individuals were furnished as : WALIER CROWE 1700 Topeka Street, Pagadena California; TOM GOOD 1743 Elizabeth Street_ J Pasadena California; JOHN STRA THMANN_ 9 1760 North Oxford Avenue 9 Pasadena , California The form II was signed "SIRHAN SIRHAN' Mrs ERRIMAN advised that she was furnighing this original form for the use of the FBI She stated it is signed by SIRHAN and was probably executed by him as these forms are normally filled out by the applicant 0n6/7 /68 Angeles , California -Filelos Angeles 56_156_ bygA THODORE E CHILDRESS/vjh Date dictated 6/7/68 This document contains neither recommendationg nor conclusiong of the FBI. It is the property of the FBI and is loaned to your agency; it and it8 contents are not to be distributed outside your agency. 672 Lq? ================================================== Page 5 ================================================== Jr 17 FD-3 02 (Rev. 4-15-64) FEDERAL BUREAU OF ` INVESTIGA TION Date 6/8/68 KATIE COFFEY, Secretary for Dr NELSON , and whoge reeidence is 11315 Laverne 9 Riverside , California 9 advised that she recalled SIRHAN SIRHAN coming-into the office in the fall of 1966, after he had been thrown from Of & horee _ ft She advised that he was a very nervous and jumpy" person: and ehe talked to him on a few occagione attempting to him to settle down in the office and not to be 80 upeet while awaiting the Doctor She said that from the elight convereation ehe had with him, he appeared to be an unhappy and nervoug person who gave the impregsion he felt like he was being picked on most of the time She said that he eppeared to be very self-conecious about his very small size She had no diecugeions with him of a political or eocial nature , and talked' with hfr ln an atterpt to calm hhir down 4 On 6/5/68 at Corona 9 California File # Log Angeles 56-156 by SA LANFORD L BLANTON/ejg Date dictated 6/7/68 Thig document containg neither recommendations nor conclusions of the FBI. It is the property of the FBI ad is loaned to your agency; it ad its contents are not to be distributed outgide your agency. 673 get ================================================== Page 6 ================================================== FD-302 (Rev_ 4-15-64) FEDERAL BUREAU OF INVESTIGA TION Date 6/8/68 Dr RICHARD A NELSON_ 9 Suite 7_ 9 750 South Weshburn_ Corona 9 California $ advised that he recalled treat SIRHAN SIRHAN for an injury received from a fall SIRHAN SIRHAN wa.s thrown from a horse while he was employed by the Granja Vizta Del Rio Farms He was first seen on September 25 , 1966 $ when he was brought to the Corona Community Hospital Dr NELSON said that there was no serious injury incurred He waa admitted to the hospital by Dr NELSON on September 25, 1966, at 12:30 p. m He was released at 1:35 p 1n on september 26, 1966. Dr NELSON wanted him to 8 in the hospital longer but he was very reluctant to etay in the hospital and almost a belligerent patient _ X-rays were taken of his 8 kull, back, shoulders 5 and arms and they were all negative _ 'There was no permanent damage incurred in any place fronl this fall SIRHAN was 8cratched extensively and the injury was painful for 8 few daye but was not serious ;4 Ar NELSON recalled SIRHAN queetioned all of the medical applications and al1 medicines administered to him, ana appeared unduly frightened of the varioug treatments Dr NELSON said that he appeared to be an angry young' person 9 but that he did not give it much thought at that cime He said that he does remember him very plainly because he wa: one of the mos t reluctant patients that he had ever had Dr NELSON furnished the copieg of al1 the medical records at the Corona Community Hospital_ J and furnished these to SA BLANTON After SIRHAN Was released on September 26, 1966, Dr NELSON saw him again on September 29 , 1966. Notations were made in his own records that he was healing 9 and he wa.s fully active at that time He 8 aw him again on October 26 , 1966 , in his office_ 2 and SIRHAN appeared to be completely healed He complained of a little trouble with his lefc eye and Dr NELSON referred him to Dr MIITON A MILLER , 824 South Main, Corona 9 an optometrist 6/5/68 Corona , California Los Angeles 56-155 On at File # SA LANFORD L BLANTON/s jg 6/7/68 by Date dictated This document containg neither recommendations nor conclusions of the FBI. It i8 the property of the FBI and is loaned to your agency; it and its contents are not to be digtributed outside your agency. 674 ing tay ================================================== Page 7 ================================================== LA 56-156 Dr NELSON *again stated that SIRHAN ' g injuries were not serious and were only dirty and momentarily painful_ Attached 18 a copy Of the Corona Community Hogpital Records pertinent to SIRHAN SIRHAN made available by Dr NELSON 675 ================================================== Page 8 ================================================== 6{2 WASHBURN AVE_ DR.CALLED b-z CORON} CALIFORNIA 91720 PHONES 737.4343 638 - 0093 REPORTED ER 4179 NAME Sirhaa 8nhs DATE i4ks]66 TIME 2 P.M' ADDRESS CL_=_ Fo__e+a CKIEF COMPLAINT CiTY 4 SEX L (x PII DATE OF BIRTF ONE S 12L3 SOCIAL_SECURITY_NO PII RESPONSIBLE PARTY E4Li4 0sa ~s+_ Rla TREATMENT 0 ADDRESS J_3E0 @8xs > Cen8a EMPLOYER ZZWw" ADDRESS ( INSURANCE CO ADORESS GRQUP N? CERL NQ CCIDENT NATURE, DATE, WKERE) 2efr-@ 14 Ut-o~? 2z -P Sec-LC EMERGENCY ROOM CHARGES 47U PROFESSIONAL FEE SUB TOTAL Ueoz} XRAY LABORATORY TOTAL DisPoSITE_ NURSES SIGNATURE ULL PHYSICIA% Md_ CONSENT For TREATMENT Knowing Ihal om slffering conditicn requiring diogozis ond mediccl Or surgicel treclmert; veluntariky conseri {o such procedures and hospilal :ar? medical, surgica; or xray teclmenf 05 is deemed necesiary in #ha iudgnenf o {hg Jl'yrJing physician: amcoare !bc: Ihe racic? oi mejicine is nol an exach szience and oclncwledge Ihal no guararlees hJve teen rlade to nie 0s lo the res lis o} freotranl or exminction in Ihe Haspilal. This form has besn fully elincd Io me acd certly thof undarseaa:l ils confan:s_ Jls? he:eby assiyn al madicol and surgical cnce benf1s to !hiu J leading physician's} und &ll hospiti ana' discbitily inguorc? bareiits. Otherwisa poyctl? to ma I? #? hoicilgi alsa designote ;he hoscit:]l and attendirg physiion s; lo ac} 05 my atrney I colig' any such bonef "p Io 'ha %ol3l aiauri billed !or {&c; and S2:v{05. Jlsc expressly autharize #ke kospitul &nd ciending ?hy sicians Io {e/8se all information required ' colia:l sch {ens: Shkis- Signed {or Patienl Patient by (REASON NorSIGNEO 8Y PA;Ent) RELA TIONSHIP 676 Pi MEDICAI REcORDS L 7af 421-" $ s1-( L brl hereoy dicsn In;u' ================================================== Page 9 ================================================== Icpilol Dalc Adm_ 9_25_66 U.mX. 12.30_27 AdmsscnForM 4. 215-1_ Rote 836.50 Dote Disch ~9-6_L6 6) N CORONA CcMMUNY HOSRTAL Arlvance Paymiert_ Pvevious AdmissicX smuun Dwe No'a SIRHAN MR, SIRHAN_ {Ins :oepitol No_ Yes jo:1 Iuliul #ilui % Oule 8Qu Previous Adsio Pencs"ri #4:ess 696_East_Howard (mer dupilal Yes Streel Y{net Mei: Locul Pesedene,_Celifornia 8Y8-2136_ Adress Seme Skate M ialienf' s A,} 22$ M #i!h Uol_ 33-19-4+ Mcu ilagl Sic' s S Soc. Sve No. Religiou: Ftct Cauc WrtinIcce Nnlirulily _ {'relerec& "tian: Oi;'chin_ Exercige Boy Lnglynd Bx Altfillisch_Const_ Co_ Rt, Boz_159B Corcna_ Calif '37-5275_ Steel {.17 J6 I - Ni Wca Sirhan_ Father Aedress Samo Re. Snet Scr_ Sc No mg loye:d Phone Muv 1n1:} Aetlte: , Sref Cily P'Ru:e Industrial_Accidont V; Pulicy 15 {# Goup NJu. C 'le W'i W f"_ nbulance Suryica & Dr R Neleon 737-5892 Aamnitted By Gele_Norbuts_ 760 Washburn Cowona {vicm.m {iojsi:_ Jultiple_Gontusiong_end Abragione,. Seyoro_Back_Injury 7*8:1 Lt_ 0} &. LX {f" 0C_:-1y CZ~ 7~: 7z9 inl firgnu:i:: Cocic No_ 9n $.0 cuyplicel;ons: 879.6 Jr2 ~la" 930 Ov"r #i.xn L 4C L. L C _es-c-t-ea 8,2) 29.4 cne Uf; ". {JDi?d 348 Hrs I0 Dxw #dl Dingnosi: Ou; i~u: Ir: 1 #wsv Yin to m "nairio N:7988 pa" C? No " W 7J I;re (56-62"7 I: ================================================== Page 10 ================================================== CogonA CoWXnY Xosx CORON, CALIFORNIA RELKASE {F RESPONTSIBILITY This is t0 certify !hafl !; SIREAN }. SIREIeN hercly releasc th2 Ksspital rom all responsibility for Icss or camare of any personal artic&5 lefi ir) my possessiori, or cny items brought into thc Hospital during my hospital- izomjon. hiave bsen cvised by ihe Hospital to refurn any unnecessary articles to my korne, and frik? full responsibility for retainirig in rny possession any crticles which consicer nsc essary, and for.fhe removal cf these article from Ia Hospital premises at the fime o dis- charge: valuables placsd bY me info thic Valvables Envelope No. are itemized separnlely on tk? fcce of Ihe envelopc and placed in tha Hospitol saf8. DATE: .9-25.66_ SIGNED_ Y PATIENT WITNZSS Uirtn unurt5= IF PATIENT IS A MINOR OR IS-UNABLE TO SIGN, COXAPLETE THE FOLLOVMNG: PATIENT IS A MINOR. ~(STATE ACE}; IS UNAELE TO SIGN EECAUS:. 000[7[0 DATE WITNESS_ Signature (Stcl: Relctionship) STRHAIL SIBTAiL 21 Lint Dr_87_3al0 77933 Narna Las} Firs} Miclala Rocm-Bed Amerding Kosp. No. DEL34S3 QF RZSPOTSIBILIII 678 Any Phys. ================================================== Page 11 ================================================== CONDTTIONS OF ADNZSSIO) to CORONA COMMUNITY HOSPITAL A copy of this Document is to be delivered to Ihe patient. 1. Gengral Duty Nursing; The hospital provides only general nursing care: Under this system nurses are called to the bedside of the patient by & signal system. If the patient is in condition as to need con- tinuous O special duty nursing care, It is cgreed that such must be aranged by the palient, or his legal re- presentative, or his physicians, and the hospital shall in no way be responsible for iailure to provide the same and is hereby released irom any and all licbility arising frorn the fact that said patient is not provided with such additional care 23 Mediccl and Surgiccl Consent: The patient is under the conlrol of his allending physicicns and the hospital is not liable for any act or omission in following the inslructions of scid physicians, and the undersigned consents to any x-Iay examination, anesthesic, medical or surgical treatment or hospital services rendered the patjent under the general and special instructions of the physicians 3. Release of Inforrotion; The hospital is authorized to furnish [rom patient's record requested information or excerpts to any insurer of patient 4 Personcl Vcluables: It is understood and agreed that the hospital maintains & sale ior the safekeeping of money and valuables cnd the hospital shall not be liable for the loss or damage to any money, jewelry, glasses, dentures, cocuments, furs, fur coats and fur garments Or other articles of unusual value and small compass, unless placed therein, and shall not be liable ior loss or damage to any other personal property, unless deposited with {he hospital for safekeeping. 5_ Financicl Kgreement: The undersigned agrees, whether he signs as agent or aS patient; that in considerd- tion ol the services to be rendered to the palient, he hereby individually obligates himself to pay the cc- count of the hospital in accordance with the Tegular rates cnd terms oi thehospital. Should the account be referred to & attorney for collection, the undersigned shall pay reasonable ctlorney's tees and collection expense; All delinquent accounts bear interest o the legal rate. 6. Insurace: Iunderstand that, if my hospitalization is covered by insurance of any type, it is nevertheless, my personal obligation to pay for all hospital charges &s presented by the above mentioned hospital. I hereby consent that the hospital may request any insurance company concerned with my hospitalization to name it, the hospital, upon all settlement or recovery under such insurance Tlle undersic-ed certifies thcrt he has read the foregoing, recei copy thereof; is {he patient, oris duly culhorized by the palient (s patients general agent t0 execute the above and accept its terrs DR RLGHARD_NELSQM_ SZRHAN SIRHAN Aftending Physicicn Paticnl' $ Nomc Dote Hour LClz Palient Whiness Dote Hour Relalio;ship Wifacss Dai Hour Relotionship Witncss 679 HOBART PRESS duty such ving and ================================================== Page 12 ================================================== 812 !VASHZURN AVE. # . N A V DR_ CALLED_ K 1elswzu CORONA, CAIIFORNIA 91720, 742 PHONE5 737-4343 658-0093 REPORTEO ER 4045 NAME Sixhzn,_3 whez DATE 9_2,56 6 TiME 8 34 FAZ ADORESS 62962_ Heulakd CHIEF COMPLAINT CIIY 42jSa-L_t Industrial_accident,-kas_riding-race-horse when SEX Youle he_an_into_fence_and_fell,_Sustaining_injuries DATE OF BIRTH PHONE ~4p-8213.6 as follows: PII SOCIAL SECURITY NO_ 4 RESPONSIBLE PARTY Sef TREATMENT J Ilel L) ADQRESS_ 6 EMPLOYER PIILIE542, Eiuk Cc Newubusyl A0 Vzz ScX-L ADDRESS Bs_1f9P Ri_I 8167& DOzleiy 9 WNSURANCE CQ Laceration of Teft upper Tid Tmedial) ADDRESS -Bilateral-sznd-foreign bodges in eyes } GROUPNO CERTNO Laceration-of-chin;-comple: 9 5-cr-total ACCIDENT NATURE_ DATE_ WHERE) ~EkeiqiL P2ah Large_contusion_of_dorsal-baek fkSe_ 6-2-5-6ka fi%522 Contusion )ot hand { 1 JE+c Usl 7ez_72 Multiple Zorasions 250&u 43] CzLxus Z3229 232 Lble(2re2 FYPERTET given EMERGENCY RooM CHARGES 15 68 Hospitalizedforfurther-care Suklst _ S_zI Nubetal_Sactktn 9-_UJL 53 Pccp_~jzcf Oj PROFESSIONAL FEE Sub TOTAL X-RAY Salns LZ 52 Skvah 75- Scs SlusxslsLxc 15 Do ikcesLJ 12 52 A 1f 6 Qa LABORATORY TOTAL C11 DISPOSITION Hospitalized NURSES SIGNATURE U Ss PHYSICIAN Richard-A.-Nelson,-#;D . MD CONSENT FOR TREATMENT Knowing thal ar) suffering condifion requiring diagnosis and madical or surgical treafmenf; hereby voluntcrily conseni to such diagnostic procedures und hospilol care, medical, Str ;kc! or Y - ry Ireotnen: 0s is deemed necessary in Ihe iudgment cf #he cllending physicicn om aware Iha} tha proctice of medJicine is nof an exoc: scicnce on: 02 'Inowledga Ihaf no gearcntees have been mada to ma as lo tha resuls of Iredinent or excminatian in Ihe Hospital, This 'form has be2n fully nkined % me and certily thaf underskind its corten:s. olso hereby asign all medicol anJ surgical insurance benefils Ia tha at tending physici-nis} Jnd alRasp*3! Jnd disobili:y insuranze benels, otherwise coycble lo me_ lo Ihe hospilal, also designate the hospilul and altendirg pl:ysicia?'s 1o oc} GS my Jmorncy Io { lec: ary surh benel;ls U; 1 ie !'al Onhjum bille: fur iees and serviees. Glso expressly aulhorize #h? hospilol and cllerdiny phy- sicions lo release cll in}c: tJiWJn reguined % cllec} such iees Signed for Paljent #tellc. Patienl by L/hleui EASON No1 S{NED 6Y PATIENT) FELATiONSHiP 680 Z c6 MEDICAl RecoRDS Sqv_ ~2 ================================================== Page 13 ================================================== Approved by the American Hospilal Azsociation hos?iial FEcULRTioN: All posiiiy? ond Iom} negnfivo findings shall be rccorded_ 9-25-66 11:30 am a.m. Duto_= Hour_. 8E AP.m. Problen; Fell from race horse , hig fence, sustained multiple injuries: Contusion of the left subscapulax-dorsal area Laceration and heratcma of left upper lid Bileteral sand foreign bodies of the eyes Contusion of the left hand Lacerations of the chin-neck ORDER OF Multiple superficial abrasions RECORDING 1. Chief Comploint This 22 yr old Arabian mle Fas riding 8 race horse Khen it veered toward tche 2. Hlistory of fence and he fell off , causing the above-described injuries He vas brought ir Preeanf Illnes3 by &mbulance Clothing was renoved and the above-described injuries noted and 3. Kispory of treatd Pas; Illncss 0) childhood Eyes were irrigated with saline after %% Pontocaine 0 Neosporin ung b) adul} Chin laceration sutured 2) oporafions Spine 5 hand 7 shoulder Films reviewed byo Dr _ Deeb , most probably negative 8) injurics 4. Family Hiiery 5. Social Kislory 7 . Signalure Patient has never been to a doctor no major previous injuries _ No surgery , @) Gonaral no major medical illness _ Denies knoxledge of' TB or Cancer or diabetes _ b) skin 9) Hcaj-Eyc: Systen review is totally negative. Ears-Noj?- Thrcc} &) Neck Background; has been in US for sore years studying 3 apparently has finished 0) Respiratory college $ but prefers riding horses , has aspirations to beconle 8 jockey . 0) Caxia- vasculor 9) Gast;?- intestinal 6) Genito- urin JrY j) Gynzco- logical 1) Locomolor k) Neuro- Psychiatric 6. Systmic Revie)v Name-Las Firsf Middle' Hospi;al No. Sirhan , Mr , Sirhan 772 Room No_ Clinic or Service snendinc F:ysician Surgical A.Nel3sni,MD 681 Nistosx -66-ICOCH imnpor gtts ================================================== Page 14 ================================================== Approved by the American Hospital Association HOSPITAL REGULATION: AIl positive cnd imporlanl ncgotivc findings shall bc recorded_ 9-25-66 11.30 am a.m_ 22 Male Date_ Hour ~P.m. Agc___ .Sex: Hloight. IIcte Heigh_ 76 reg 116/82 Temp__ Pulse Blood Prcssure Ceneral appearance: Young adult dark-skinned male lying on a stretcher in severe pain, covered from head to toe with dirt_ left eye is bleeding and he complain8 of in the shoulder He is alert , nervous , but cooperative Head: Me) laceration in left upper lid which is bleeding actively, with: fairly large hemacoma of the lid. Laceration is near medial canthus ORDER OF Pupils are equal 9 react normally _ Both conjunctivae have a large amount RECORDING of 1.General 2. Skin Face: no other injuries 3. Eyes Neck: 5 Cm laceration of chin , compound 9 closed with 4-0 nylon sutures 4.Ears 5. Nose Thorax: normal bony thorax no palpable or X-ray evidence of fractured ribs 6. Mouth lungs clear, heart tones good 9 no murmurs 7. Throat 8. Neck Abdomen : flat , no scars , no tenderness , no masses , no hernia noted 9.Chest I0. Heart Rectal not done M1.Abdomen 12.Genitalia Genitalia normal to inspection and palpation_ 13. Lymphatic Extremicies 14. Blood Vessels 15. Locomotor Right shoulder also lefc 9 slight tenderness X-rayk neg superficial abrasior 16. Extremities left hand has some contusion and slight discomfort filns neg 17. Neurological Lower excrenities: nnxna normal , no evidence of trauma 18. Rectal 19. Vaginal Reflexes normal 20. Diagnosis 21. Signature Impression: Mul6iple external injuries as" noted Advise: Betailed emergency room care donel Hospitalize for further treatment and observation N'ame_Last First Middle Hospital No. Sirhan, Mr Sirhan Room No, Clinic or Service Itending_Physician m Surgery Melsen-MD 882 CORONA'COMMUNiTY MOSPITAL PXYSICAL EXAMINATION XobaRT PREss (Form 104) 4-66-2000H Resp_. pain sand Dinro ================================================== Page 15 ================================================== Corona Community Nole Progress of Case, Complicationa Consultations Change in DATE Diagnosis, Condition On} Dischargc, Instructions to Palients ZLL: Xh-CUl) x 77-8171 PRocrzss RECORD, Name< No_ 2 ,5 3 HOGART PRESS iFormn 123) Hosp ELS Hosp. ================================================== Page 16 ================================================== Sirhar, Sirham} Ward 215 Hosp. Noa_ 7453 Or Room_ Nomo_ SIXT% REPORT Richard Nelson Lob. Noa- Docror 7 Spatimon Kohn Xolmet #cs 3#0 [ntin}n ; 5 Klino _ ~Non-Rcactive Mariini_ 6 V.D.R.L 1 Blood_Agglutirations: E. Typhi 0_ : Para }, Para fo. Aborfus_ P. Tularon: Qthor Tasts_ E 9723766 3 FFTX REPORT Dalo Tachnicion Celd M_ #e ECri0ir_2L33RL7 +erou+X Ti. OMM TMI-c DANCO-S F SrOLOc 1 F Doctor_ IV ( L;d- Lob. No_ Color_ Choractor_ Raoctlon_ 2 5, G, 2 WS B. C Sp 8 Albumin_ R. B. C._ [ 3 Ep. Colla_ 6- Acotona Casts_ Diocotic Boctorio_ Bilo_ Crystols_ Othor Tests_ 19 FOURTH REPORT _ 1 g o5/57/772o s Tochnician URINALYSIS 1 Namo_ 4 % Li:d, "aroom_ 2 /5 Hobp. No_ Doctor _ Ili L ; c Lob. No_ Color Index Rollculecyto= -Platolote ClotlIng Timo Blso Jing Timo_ 1 . R 0_ C Hb 9 _ CS TL DIFFERENTIAL: POLYS. LyMPHs Kelos_ Eosins: BASO_ Monos. Total Non-Sog_ Soa. Totol K Tofa/ 1 N | 2 B 5-7 I-/2 2N Sod. Ralo_ Cor. Sod_ Rato_ Homatocri:_ C lood Vol, Romorks Pato Tochnlclon To. FOmM 781-0 QANCO-;. 0 BLOOD (Morphology} Sugar _ ] 3 ================================================== Page 17 ================================================== C 0 R 0 NA C0 MMiN]TY H0 $ PiTA L DATE 9-25-66: _ G' G 8 |1 2 W / $ K6 U ? M ~5 C0 RO NA cA i NIF 91720 TeLEPhoN E (7 14) 737-43 4 3 8 8 - 0 0 9 3 XRRAY ROOM FAUL H_ DEEB, MD: AND J_ W. KizZiaR, M.D: {DIOLOGISTS MILHI NAME $/% i/ 1#) 5/Rxlez PT. NO SIRIAN , SIRHAN RRadiologiz Consulianion Roquesi DOCTOR: 631'2 kelsbn `e kso AGE 212/ SEX `7/341, X-RAY NO. 5 8381 EXAMINATloN REqUES TED ExiMIMATIoN PEEFORMED CODE Tj "1 'Lh FJRFIO281 CU,_ THORCIC SPINE 24 Yp21 kn_6p SKUL LL S12 122+2 fT SijtDER SSL bas? LEFT RAND Iybvn> 7828 PREVIOUS WHEN? RACE Hzisht WEIGHT WALX CART To BE COX?LETED X-RAY XERE BY RZQUISITIONER YES 0 No } Arme. 5 1 12 CXAIR D PORTABLE SUMMARY OF PERTINZNT HISTORY PhYsicil FINDINGS AND ALL PROVISIONAL DIAGNOSIS (To EZ COMPLETED BY REQUISITIONER ) FoR X-RAY DEPARTMENT RADIOLOGIST TECH_ DICTATED: 9c26-55 DATE-/ -7, TCZ 14 X 17 Io * 12 USE ONLY 9-26-66 Mcc/i TRANSCRIBED: :iX 14_ 8 * {03 TIME REPORT OF RADIOLOGIST SKULL : The: exanination of the skull shows the cranial pattern quite well The information of 3 fall fromn a horse is reviewed The film8 do not show evidence of depression Oj fracture A prominent vascular pattern i8 8uggested near the vertex_ The sella turcica is normal and porcions of the cervical is included LEFT SHOUIDER : The examination of the left shoulder failed to show evidence of fractlire of dislocatio n The joint margins are preserved Portions of the lungs and Lpper ribs are seen . THORACIC AND LUBAR SPIE : The examination of the thoracic &nd lumbar show3 the vertebral bodies fairly well On one view there is a shadow inv olving T7 but this is not supported by other views and deGiticeabvic evidence 3f compression fracture is not s2en If the patient should have perhaps oblique views Jvould be of value The adjacent ribs incidently ar2 seen end appear intact LUMBAR SPTE : The exaninatizn of the lurbar spine shows n) corpression of the vertebra or spaces The transverse processes are te well outlined The lower ribs are seene No rajor bone defect is visible Portions of #he pelvis and regions are included LEFT HAND : The exemination of the left hand shows no fracture or dislocation COVCLUS IOV : No gross bone defect seen in the spine , left shoulder 5 left hand or skull CODE: PHD :pjp SIGNED_ PaulH Deeb M.D_ 685 RADiOLOGiST HoJXM? ?arj5 Epsi cfe- spine spine pain qui- hip ================================================== Page 18 ================================================== 7 Gul imjurdes E0in? 92 4 nra Prn Riertd Xelson C*3e; Avf 3: 72 X33 686 pein C3 ================================================== Page 19 ================================================== 62 &03, YWuWuW ( 8 4 1S J| 1 & 1" Bu Day P. 0. cr P.P_ 2a Dale Izl 7 9/2s %49 A_M. P.M A.tA P.M; A.M P.M: A.m: P.M. A.M, P.M H0 U R 4 8 12 4 | & |i2 4 | 8 12 4 8 |12 4 8 12 4 |.8 {12 4 8 12 4 8 12 4 8 12 4 8 12 150 1069 1 140 1058 0 8 130 104 120 1029 { 3 110 102= Z 00 1 101' 90 1005 80 99 Normal 70 98 60 970 50 96 = Respirations Blood Pressure FOb MEDICATIONS DOSE rlauni42 2 | 3 | 4 |5| 6 | 7 | 8 9 10 |u2 | ! | 2 | 3} 4 | 5 | 6 | 7 | 8 9 10 1 12 PRIcE i Gzut @i Lle_y NARCOTICS STA} #ED:CATONS SIGNA TURE QF MiEDICAIION NURSE 1 7.30 % 687 O4 1 [AS0XE RSSfMaNO_ #Fr DIG PHYSICEN Sic }4n Siv %80 9-35-66 21si 9988 | & Nzls on7 WeV ================================================== Page 20 ================================================== CORONA COMMUNTY HQSPIIAL P,O.or P_ P_ Dale A.mA P.M. A.tA. PM A.M, P A.M. P.M A.m P.Ni Hl 0 U R 4 8 |12 4 8 12 4 8 12 4 8 |12 4 8 12 :4 8 12 4 8 12 4 8 12 4 8 12 4 8 12 150 1068 1 140 105o 130 3 104" 120 1038 1 2 110 1029 2 100 I 1019 90 10os 80 99 * Normal 70 98 60 970 50 96" Respirations Blood Pressure MEDICATIONS DOSE E 12| H| 2 | 3 | 4 |5 | 6 7 | 8 9 10 |/n2 | u| 2| 3 4 | 5 | 6 | 7 | 8 | 9 |o 1U 12 PRicE Nzes , Qstotot ( L;; D2y_4 434 QzxLI Sz NARCOTICS STA T MEDICAIONS SIGNA iURE 1;JQ OF AEDICAJION NURSE 1 7.30 % ZurLez R2) LAS; Rjo {10_ HOTFi: No ENUING MAYSiCIAn 7,7 35/ 7 2 2/5-8 47, / KF Day Pncin 2 Yhn 42 ================================================== Page 21 ================================================== COBOXA COMMUNITY Hos?i CORONA, CALIFORNIA Do nof write cbove this lina or on back cf poge. Un Datc Hour Deecriplion f Paliec?: Condition: Do nal charf ;outina TPR, routing or Rx: &n Inis fcrm, Nurse' $ Signature 30 U2sk4 Lxza1 La4 LlxZ 5 62 64 1 E_LS_ RnL (p K-16 (peide Sk 4-2-5 L' fn 2z 3 77; 2 81 Laxa € 440 ~2 EZzh Esf :1 0e ZZ 2 2: 2: cA_s UeaZl K NURSES' NOTES Name_ 8;bab 0;;h? * 688a Z222_ Hosp. No._ ccre, ie 28+- lepew Oei Ce NesR ================================================== Page 22 ================================================== FD-302 (Rev. 4-15-64) FEDERAL BUREAU OF INVESTIGATION Date 6/8/68 ARLENE CANCEL , Secretary to Doctor MILTON A _ MILLER 9 Optometrist 9 824 South Main, Corona 9 advised that she recalled SIRHAN SIRHAN come into this office for treatment She recalled very little about him except he was a very nervous and impatient type of patient 689 06/5/68_ Corona 9 California FH8# Angeles 56-156 s8y LANFQRD LS BLANTON indm Date dictated 6/7/68 This document containg neither recommendations nor conclusions of the FBI. It is the property of the FBI and is loaned to your agency; it and its contents are not to be distributed outgide YOUr agency. ================================================== Page 23 ================================================== 'FD-3 02 (Rev. 4-15-64) FEDERAL. BUREAU OF INVESTIGATION Date 6/8/68 MILTON A MILLER Medical Doctor 2 Optometrist 9 824 South Main_ 9 Corona,Caiifornia 9 advised that SIRHAN SIRHAN had been first seen at his office on November 8 , 1966 , for an eye injury and gave the history of being thrown from a horse while working as an exercise boy SIRHAN gave the history of being thrown from a horse While working at one of the local farms He was referred to Doctor MILLER by a General Practitioner 9 Doctor RICHARD A NELSON: He examined the eye of SIRHAN and noted in his records that SIRHAN seemed to exaggerate his injuries, that- 20-20 vision was found in both eyes and that there was a small view of vision in the left eye that might have been restricted in a slight way He saw him again on November 14 1966 , November 22 5 1966 9 and December 20 Doctor MILLER noted in his records on December 20_ 9 1966 that he believes that SIRHAN was a malingerer When he last saw SIRHAN on December 20_ 9 1966 . 9 SIRHAN told him he was no longer employed in this area and waj living in Pasadena Doctor MILLER referred him to a Doctor KOEH in Pasadena and stated that he was glad that he was no longer in this area He said he told SIRHAN that he could not write a letter to his insurance company , stating that his injury was not- of a nature wherein he should collect compensation He adviged that STRHAN eppeared very angry and nervous 9 but that he had no discussions with him and recalled no conversations in the ffice with SIRHAN He does recall that after he had seen him on the last occasion December 20, 1966 at approximately two hours later 9 he received a telephone call from SIRHAN SIRHAN told him something to the effect that if he did not do what II M he wanted him to , he would get him SIRHAN did not say how he would get him and did not Doctor MILLER time to answer him but hung up the telephone Doctor MILLER said he did not make a report of this to the police department as he merely passed it off as an angry young man and besides 9 he noted that SIRHAN did not say how he would him; 690 On 6/54/68 aCorona ,California Filelbs Angeles 56_=156 $4 LANFORD L BLAMHON ndn Date dictated 6/7468 This document containg neither recommendations nor conclusions of the FBI. It i8 the property of the FBI and i8 loaned to your agency; it and it8 contents are not to be distributed outside your agency. 1966 . give get ================================================== Page 24 ================================================== FD-3 02 (Rev. 4-15-64 ) FEDERAL BUREAU OF INVESTIGATION 1 Date 6/7/68 E GJRDON KIEHN M.D., Eye Physician and Surgeon_ 9 Suite 203,"48 North El Molino Avenue 9 Pasadena 9 was interviewed concerning his knowledge of SIRHAN SIRHAN KIEHN was advised of the identity of the interviewing agent and he stated that he had treated SIRHAN for a work related eye injury sustained on or about September 24 , SIRHAN SIRHAN 9 696 East Howard Street , Pasadena , Lalifornia telephone No _ SY 8-2136_ 9 Social Security No came to his office on February 21, 1967 9 having PII peen referred by Dr MILTON A MILLER of Ontario 9 California_ SIRHAN exercised horses at the Granja Vista Del Rio Ranch (Atfillisch Construction Company) , 13200 Citrus 9 Corona 9 California 9 and on or about September 24 , 1966 9 he was thrown from his horse and suffered injuries round the left eye STRHAN thought he was unconscious for a brief time and he was treated at the Corona Community Hospital by a Dr RICHARD A NELSON and the wounds around the eye and chin were sutured . Four dajs later the sutures were removed SIRHAN reportedly suffered a brief injury again a few dajs after the initial injury and the wound edge separated a little bit_ SIRHAN was unaware of any eye problems until he began exercising the horses again at which time he had to move his head from left to right in order to see well on either side. This was especially noticeable in the left eye Because of his eye complaints 9 he was referred to Dr _ NELSON of Corona 9 California 9 and following this to Dr MILTON A MILLER of Ontario, California STRHAN complained of twitching of the left eye lid when he looks to the left , wrinkles his forehead or makes facial movements He has had no subsequent unconscious attacks no dizziness 29 or other complaints. except that of a persistent pain in the superior nasal aspect of the left orbit_ 691 0/5/68 aPesadena Californa File To8 Angeles 56-156 SA WILLIAM G ATHERTON/ sdb 6/7/68 by Date dictated This document containg neither recommendationg nor conclusiong of the FBI. It is the property of the FBI and is loaned to your agency; it and its contents are not to be distributed outside your agency. 1966, ================================================== Page 25 ================================================== 2 LA 56-156 Dr KIEHN stated that he found SIRHAN ' s vision to be 20-20 in either eye uncorrected and he had no 8ignificant injuries to the eye X-rajs were negative _ He stated that he regarded the injury a8 having functual overlay as the injury was not as serious as SIRHAN believed _ He described SIRHAN a8 fairly neat ana clean in appearance and the aesthetic type with frail features _ He said that SIRHAN at times wa 8 very affable and pleasant but he could a180 be very disturbed at times He stated that he saw SIRHAN twice a month after February 1967 through April and then SIRHAN did not show up for about six months He stated that in the meantime SIRHAN had seen Dr FORREST L. JOHNSON and Dr ALBERT TASHMA He stated that from October through December he saw SIRHAN about once a week to drops in his eye which seemed to alleviate the pain He stated that SIRHAN never discussed politics with him and he knew little of his background Dr KIEHN advised that as a result of his contact wi th SIRHAN he did not consider him a stable person and believes that he could be influenced by others _ He stated that Dr MILLER told him that SIRHAN had made s ome type of threat over an ingurance report for the eye injury_ He stated that he believes STRHAN mentioned that M II he woula take care of him (Dr MILLER) if he did not write a favorable report 692 put ================================================== Page 26 ================================================== FD-3 02 (Rev. 4-15-64 FEDERAL BUREAU OF INVESTIGA TION 1 6/7/68 Date MAURICE W NUGENT 9 Opthalmologist_ 5 726 Malcolm Avenue 9 Los Angeles_ 9 California, after being advised of the identity of the interviewing agent 9 was interviewed at his residence concerning SIRHAN B SIRHAN 9 696 East Howard Street , Pasadena California 9 an employee of Granja Vista Del Rio Ranch 3 1300 Citrus 9 Corona ) California The employer' s insurance carrier 18 Argonaut Insurance Company 9 Shatto Place, Los Angeles 9 California Dr NUGENT advised that SIRHAN was referred to him by ANNE P TOOMR 9 Attorney_ 9 16 North Marengo Avenue , Pasadena 9 California 9 for examination relative to an industrial injury sustained on about Septenber 24 , 1966 . Dr NUGENT examined SIRHAN on October 10 , 1967 _ SIRHAN advised that he had been thrown from a horse on or about September 24 , at Corona 9 California 9 and he believed that he wa 8 thrown into a fence_ He stated that he was un - conscious for a short time and regained consciousness in the Corona Community Hospital while his facial lacerations were being tutured He stayed in the hospital overnight ana was released and about on e week later he returned to the hospital for the removal of the sutures . He returned to work at the Granja Vista Del Rio Ranch about two weeks later and then noted poor movement in his left eye with a feeling of tension and pain Dr _ NUGENTS exanination reflected that SIRHAN' s vision was 20-15,or better than normal in each eye without correction In the area towards the nose the left upper eye lid showed a very small scar remnant which had healed" exceptiona well 693 635/68 G?s_Angele8 , California Filtes_ Angeles_56-156 SA WILLIAM G_ ATHERTON, sdb 6/7/68 by Date dictated This document contains neither recommendations nor conclusion8 of the FBI. It is the property of the FBI and is loaned to your agency; it ad its contents are not to be distributed outside your agency. 443 1966 lly ================================================== Page 27 ================================================== 2 LA 56-156 Dr NUGENT concluded that SIRHAN had a most excellent pair of eyes and mos t excellent surgical_ results of a repair of his laceration in the nasal end of the left upper eye lid and there was no indication whatsoever of further treatment or complications or resutant disabilities The eye examination showed no defect of the interior eyes nor any localization of any central nervous system defect Dr NUGENT advised that SIRHAN inpressed him a8 a very pleagant ana cooperative young man _ He stated that STRHAN did not discuss his political beliefs and he had no additional knowledge of SIRHAN S back- ground _ Dr NUGENT advised that he believes that SIRHAN had obtained the services of Attorney TOOMER to assist him in a workmen's compensation case as a_ result of the eye injury sustained while employed at the ranch He stated that STRHAN impressed him as being unusua lly cooperative and pleagant in spite of the fact that his examination had reflected no physical det'ects . 694 ================================================== Page 28 ================================================== FD-3 02 (Rev. 4-15-64 ) FEDERAL BUREAU OF INVESTIGA TION 6/7/68 Date On June 5 1968 , FRANK STASIK , Miller and Ames Insurance Company 9 3600 West Wilshire Boul evard , Los Angeles_ 9 California advised that SIRHAN SIRHAN address care of Route No _ Box 159 B, Corona 9 California 9 was employed as a horse exercise for BERT AITFILLISCH_ 2 Citrus Avenue Norco, California On September 25 , '1388005 he fell from a horse_ 9 was injured_ J and submitted a nedicei insurance claim under policy No_ 2-210-056370 9 claim No _ 02 X 203445_ Mr STASIK advised that SIRHAN was apparently not seriously injured and he was treated by Dr RICHARD A NELSON Hamer Street 9 Norco 9 California STASIK further advised that more details could be obtained through the Argonaut Insurance Company 9 443 Shatto Place 9 Los Angeles 2 as the Argonaut Insurance Company had the policy on SIRHAN . 695 6/5/68 Los Angeles 5 California Los Angeles 56-156 On at File # SA FREDERICK E, BECKER/ jae 6/7/68 by Date dictated This document contains neither recommendations nor conclusions of the FBI. It is the property of the FBI and is loaned to your agency; it and its contents are not to be distributed outgide your agency. boy ================================================== Page 29 ================================================== FD-302 (Rev. 4-15-64 ) FEDERAL BUREAU 0F INVESTIGATION 5/8/53 Date Mr MEL VINYARD , Vice President , Argonaut Insurance Company 443 Shatto Place, made available his insurance company 8 file pertaining to SIRHAN SIRHAN , a xerox copy of which 18 attached - 696 6/5/68 Los Angel California #A 56-156 On at File SA FREDERICK E. BECKER/kaf 6/8/68 by Date dictated This document contains neither recommendations nor conclusions of the FBI. It is the property of the FBI and is loaned to your agency; it and it8 contents &re not to be distributed outside your agency_ e8 $ ================================================== Page 30 ================================================== :P;:o; C.5 1 CLOSING RECORD 3 INDERNiTY XIDICAL ALLOCA "zd Total 4 Delao "234' 3 22he > /c 3Z5 5 GE.1C= Zs 313443134226 3.7 [rcolc 0140 1 8 : RETURNED To 'ORK ~ 255 covp RATE INDEMN!TY {ZNS XARD wfrkly WACE 4LVice ECrs 7o Accounting bY DAT% XEEkS #8T Pj DATE APPR CHECK NO PERIOD Acint {iAl DXj J0 '12Z (G 2U03 Cj 2de 72 48 W O0 C', 83 33 0: ci mzdich' Datz 01" ISSUZ P;eeXE ?ECUEsts%,hEd ALLOCATED Ex?ENSE MAT ChCKN {EE J26 id ================================================== Page 31 ================================================== UA ^MMj ANiJn7 PAYkt CONTINUATFON COMF'EXATcN RitE COMPENSAtion ^MiRd FBSKZ" #)suu: Mc PE Ex DA7 COXPENSATION PAyreNT Code ] MEDICA L PAYmSMT CODE 2 TE2F NKEE? 2852825 UNT TotAl [R3GO= PYEE NAME EaE2 44Zk9P AiONT TotFL 'jbs 5"' 114E63n4+22124 JLS FZEL5 2Kuka212 [ZLRELFe 727.71 1zzZL 771 VIziz lez 25zyyu23442 LZeszl #azk 7z22 3-224} Zz1_ 16442162 lez7 J Feniksc|5 12 22124 16 224827 Wck 4 27 152,932 Jlo Iz) 44ng 22 21 56/0 < 2 3R JS4 1iLkz 547 5 s2[ 27 122225 GED #CARRY THiS TotAL FORWARD LLLOCkTed ExpenSE PAYKENT CcDE3 PAYEE NAME CKECK AKOUNT TotAL NO TOTAL BROUCHTT FORWARD *CARRY This TOTAL FoRKARD CARRY 7XI3 ToTAL FcrmArD NOTAT;ONS.AND STAWPS CLAWWANTS CHAWcE CF ADZRESS STREET K33AESs City xcStATE 638 9 : 21 347. ================================================== Page 32 ================================================== Pcl{at MREZR Cl Frg RascR Co. IfURCCO DATE LKE 37, bn_ e#c/Y7 SERiAL DIv ; L7z 537271 CLAcS_ 3Q-07-66 QQ CbLzo 210 056320L2_ 2023415 f03Z_ ;* CCXV AETFIZLISC COMSTPICTION CO_ 0 & INC 0 FxP, ocr: oz 259B Gozone Cal 4 Miller 6 Anes & Cali} V 6 ACC; DTE p % Fncd,Cres gY 3625 mo 62h Stt 7 Los 4n32lez $ Callf 09225-66 2L3o 5315 01-0l-6622 PCl %Er: STRNA , SIEZAR Prrr slkzwa? clo Re, 2 Boz 3593 86E eRUSE Moris Cozona__Cal2201322 Tec, @P ehZR bi2 1AT?E tbrow 40 bozge C155 Qore?o CallE. Lcc4TzcR Ricngzd 40 .W2l8on 5o3fo3 HezzezSEz, Norco 9 Calis A0j7ftS MZENITY XcxL ALLCe. ToTL CC1i?EMSatc 2z00 0J 250 co 7250 OJ 2700 RESZTNS CIAIM CLOSING ADVICE To TABILATING DEPARTMENT OLD RESERVE NEW RESERVE Indemnity S_22C 202022: Modical 425.0 40. %S Allocoted 4352 343.Y0 Tota} 85392 3434 24 Dato Division CLi-?60 699 ================================================== Page 33 ================================================== McLAUGHLIN, EvANS, DALBEY & CUMMING JOkN McLAUGHLIN ATTORNEYS At. LAW AREA CODE 213 BARRY F. EVANS 1717 North HGHLAND AVENUE , SUitE 7i0 TELEPAONE WM. BL4[A DALBEY RAY ClMM NG Los ANGELES, CALIFORNIA 90028 466 8541 AAROLD BEnNETT NED L. GAYLORD JohN BARTos April 1, 1968 GEORGE R.HASWELL ALLAN R SChUMMER ROBERT H.GILLKAM Argonaut Insurance Company 6b3 Shazto Plece Lo3 Angeles , California Re : Youz Cla:m No 0 2X-203645 Sirhan Sirhan Vs Altfillisch Construction Compeny 9 Inc 0. JltFt SERVICES RENDERED : 007 Aiiac Revfew of che file; Preparacion ad filing of Ancwer Eo the Applicacion conference vich che sub rosa Gavectiggtor and review QE pictures; crial and ePpearence before the Workmen ' 8 Compensatzon {8s8al8c Board &c Los Angeles 03 February 7 , 9 seetlement Degociacions; preparacion end filing and 8erving of a Compz01i8e and Release eement; closing reporto 8170.00 COSTS Photostet 3.00 073+- Jo7ittd APR 15 !68 CNk NO _ 26320 '5845s TOTAL : 8173.00 7xir 4ttshilRorgtzt' AmOunT_ JPkn Oeiael" OYLss pax Chs v 1h ?J 700 Agre [7 3aj ================================================== Page 34 ================================================== McLAUGHLIN, EvANS, DALBEY Cumming ATTORNEYS At LAW JOHN McLAUGALIN AREA CODE 213 B4RRY F, EVANS 1717 North HIGHLAND AVENUE, Suite 710 TELEPHONE WM, BLAIR DALBEY 466-8 541 RAY 0, cUMMING Los ANGELES, CALIFORNIA 90028 HAROLD BENNETT NED GAYLORD JohN F. BARTOS 1, 1968 GEORGE R.HASWELL ALLAN R.SCHUMMER ROBERT H.GILLAAM Axo8aat Insurance Compeny Shatco Place Los Angele8 , California Atcencion : Jo D o Stiner 9 Claims Examiner Re : Your Clesn No . 02X-203465 Sirhan Sirhan VS 0 Alcfillisch Construction Company , Inc Deer Sirs : The Referee na8 approved the Compronise and Release Agreement in che above -entitled matter and has ordered discribution at 81,705.00 to the applicant 9 8200.00 to his attorneys , 850.00 to Dr Maurice W Nugenc &nd 845.00 to Leonard J , Yanshon, MeD The Order of the Referee should be complied wich by yOlz company . We are et thi8 point closing our file and subulccing ou2 state- ment for service8 rendered truly yours, McLAUGHLIN 9 EVANS , DALBEY & CUMMINC 6R 2 %e %7Da _ By : John F McLaughlin JEM;cjz Enclosure 701 4lv 8 Aprii Very ================================================== Page 35 ================================================== COMPUTATI OF AWARD CLAIMANT ZZeet DATE INJ. 925-66 CLAIM NO. 223+45 TYPE Of TEMP . No. $ AWARD TQTAL DIS #EEXS AWARDED TEMP _ NO. TEMP . B S PARTIAL Weeks A WARDED PERM. P D % WEEKS AWARDED DISABILITY DEATH DEATH BURIAL S $ BENEFIT SETTLE. SETTLEMENT $ #_332Z-LIe QOO CONTIN: F MEDICAL $ LEGAL K GROSS LIABILITY 0oo DUE CLAIMANT To DATE PER IAc S WEEKLY TEMP_ DIS_ FROM To $ RATE WEEKL Y TEMP _ PARTIAL FROM TQ $ RATE WEEKL Y DERM. DIS_ FroM To $ RATE KEEKLY DEATH BENEFIT FROK To RA TE SETTLEMENT ATTORNEY NAME & ADDRESS GROSS DUE NOW Yapzez + [ooe/ LESS PREV. PAID S ( ( 7 /ocf; 77/jcea LZe _ SUB-TOTAL Taz = cl:?t TeEdrrt Q LESS ADVANCES 5 @ / 'SUB-TOTAL S CHECX # 62dz LESS ATTORNEY FEE S Dotet PAYEE & ADDRESS_ /aunce 7 ymY; SUBTOTAL $ 1131 0z} rSlce CKECK # [Za2Sdzzaes_ 2626/Y LESS U.CD. $ 56 ~ PAYEE & ADDRESS 67 W-cl_ Oq S7e7 , SUBTOTAL $ CHECK # 824 LESS S (or PAYEE & ADDRESS SUBTOTAL | s CHECK LESS S SELF-PROCURED PAX As Comp. MED. BALANCE MEDICAi 702 $ /,763. CHck DUE CLAIMANT CLERK 'EXAMINER_ 8 DATE: 8 DA CECK # 2634 CLM-376-R2 921 5-2 200 Fce ================================================== Page 36 ================================================== DEPRRTMMZNT Of WNDLSTRIAL rELATIONS 20 Z442 PIISONOF INDUSTRMAL ACCIDENTS WORKMEN'S CQMPENSATION APPEALS BOARP JTATE Of CALIrOrNIA SIRMA B IGHX& CAsE No, 67 Ia 312-144 Applicont VS, Order Approving ALIPtGISCH CjnOIN"II} CCDW 0 corponso? Compromise and Release "Bhe%2 IBURAEC% Cos TY, 8 corcrz Defendcnts The parties to the above-enticlec action have filed 2 Compromise and Release herein, On Mseh 3o64 sectling this case for $ COQ 0 in addition to 22 sums which may have been previously, and requesting that ic be approved; and this Board having considered the entire record, including said Compromise and Relezse, nov finds thac it should be approved; and, IT IS ORDERED that said Compromise 2nd Release is approved Award is made in favor of: SIRZAN ) 0 8IrEAN Against: AJRZOWAOF DBURASC? 8 corporasiono ef 02,OuD,Co0 Payable 2S Eollows: 81,7oS,c0 epplicgnt 20c.0o Yalyez 8 Tocmer, At2220030 SQ+00 Hiwurlee N & ` Miugent " MJD bS6CO Lcorard Ja Ieahon, MaD, hkc % MAI:; NT %0B ANOKIES , CnGIBORn Snzeb 27, 1968 3 4 %} ENZzZ K3n Rclcrec, WORKHEN'S COK?FNSATION APPEALS BOARD ERVED BY MAIL ON PERSONS SHOTA" XN THE OFFICIAL ADDR ESS RECQN Jato: 703 16 WCkifoRv 95 REY. 16.#6) FoRueRly Forh 382 161c3.:0z fI-c? {Jo% Osp 61o9 paid COa ? By: ================================================== Page 37 ================================================== McLAUGHLIN, EvANS, DALBEY & CUmiMING ATTORNEYS AT LAW JOHN F_ McLAUGHLIN 1717 NORTH HIGHLAND AVENUE, SUItE 710 BARRY F EVANS Los ANGELES_ CALIFORNIA 90028 (213 ) 466-8541 WM. BLAIR DALBEY RAY B. CUMMING March 13 , 1968 HAROLD J_ BENNETT NED L. GAYLORD JOHN F_ BARTOS GEORGE R: HASWELL ALLAN R SCHUMMER ROBERT K. GILLHAM Workmen's Compensation Appeals Board 107 South Broadway Los eles 9 California Re: SIRHAN SIRHAN VS ALTTILLICH CONSTRUCTION COMPA NY WCAB File No. 67 LA 312 146 Hearing Date: Gentlemen: Your attention is respectfully invited to the {ollowing: (Y Attached please find duly-executed Compromise & Release or your approval Request is hereby made for further heari to permit cross-examination of and presentation of. rebuttal evidence: Please enter our appearance as attorneys for Please set case for trial as there are now issues in contest. Attached for herein are: Copies to: truly Yours, Palmer & Toomer 16 No Marengo McLAUGHLIN, EVANS, DALBEY & CUMMING Pasadena , Californfa 46383285L15 Insucance Company Lod By: Jotin 16 McLatghlin S8 704 bnge ring filing Very Ave _ ================================================== Page 38 ================================================== INs_Xuctions 1 Do not use this forl in dleath cascs Usa Forin 18. Do net use in'thidi-Qarty cases. Use 17. !f tc injgred employee bc uder 21 years of aga ane' & Zuardivn zdl liter has not bcen previously appointed, a pelition for appointment 0/ of guardiau ad Vitem 2nt' trustec Iuist accdinpany ti:s a; reeinent. }. The guardian must sign this agreement on bclalf of an injured clployec Who is under 21 years Of age If the minor is ahove Ihe age of 14, such mitor shouldl ulso, sigi tilis agueevent Attach all medical reports not heretofore suimitted to the Wlorkmen's Cempensation Appeals Board aud advise when other were filec, WOR KMEN'S COMPENSATION APPEALS BOARD DIVISICN OF INDUSTRIAL ACCIDENTS DEPKRTMENT OF INDUSTRIAL RELATIONS STATE OF CALIFORNIA COMPROMISE AND RELEASE 'CASE N0.6l_1A_31223444 SOCIAL SECURITY NO PII B 696 Esgz lovard (Mr:) (Mrs) (Miss) 3EKAN EZKNAN Peqasenep-GslASornia VS_ Atplicant 2 PRAES8 PoO. Dc3 259E-Bsure 2 ALIRILLICE_COXSIRIXTNA_CCZAN GaronesCnlEZorala CORRECT RAME Of EXPLOYER ADDRES? 663 Snaees Plaee' ABGJRAVZ INSIRANCE_GOYMPANX Loa_Angelea Callfornl coraECT NAME Of INSURAXCE caRRiER ADDRESS The parties hereto, for the purpose of compromise only, hereby submit the following statements-of-fact: P ZASIEEAv employee herein, born on_- claims that he was employed on the 25681 of_Snpcoaatzz 1966 Lac_ Gozone_ V" Cal:Eoznia (MOnTH) (YEAR) (City) (StATE' 2s 22 by_ AlaEtlllch_Cccetz2eelou_Ccmpany then insured as to (occupition) (NAHE Of EmployER) vorkmen"s compensation liability by 1383n346_Ir3422320C83722r and tht (STTE NAXE 0f CARRIER OR WKETKER Self-INCURED) he sustained an injury arising out of and in the couirsc of his employment as follows:-Ev ~0032 41385 2 83-&-4023 R Cwo8--%834 2tina-%5-{2l6splo-Iogwsc3 &2e-kond-t 8982 823 2 The actual 3298432 _ of the employee at the time of injury werc $-373,00-8,-Zsakkyhile the average weekly wages were 3. The employee's present disability is L8PugRFFE PRESENT Disadility RESULTING FRo4 TXE ihJury} and the employcc has -returned to work (IF EO, BTATE WhEN) 4. (a) Temporary disability indemnity has becn to the employee in the sum of S at ~per week beginning to and including The amount duc and unpaid to the employee is (b) Permanent: disability indemnity has been paid to the employee in the sum of $_ 8820-- covering to 5 Thc parties hercby agrec to sctcle any and all claims on account of said injury by the payment of the sum of in addition' to any sums heretoforc by thc cmployer or the insurer to thc employec, said sum to be as follows: "85 " #2se-1481-0l2l5-02 Biatjzlce-W ~Essnc {5 6h2 032J 0% 5Q ard Yanagkec 183 tbe 91m 0f 845 .00 p 103& 2 6. Medical and hospital expenses have bern $ by the cmployce and ~by the-employer or <rrier. Unpaid bills amount to tfs Frturc medical and hospitil expense is estimatcd at $__ nloze Unpaid ani} {ucure medlical and hospital cxpcnse is to b #esued as follcws: unnehonised defendants 60 I: 3844-k GPplla:ne XM <4 Eactro? m8diecl Brd Roopitel @Sper0e3 60 &0 0 rne Ppllcr 0M WCAR Fsn 5 rAet 1GEV 1.0a 705 r FMrti Fcrm:43 956-; 602 ;.67 ;0M#7< reports 5-: agreed day paid period_ Paid payable 9rt" paid [y b} 5ar ================================================== Page 39 ================================================== 7_ Name and address of employee's attorncy, if any_ algrr_an4 _ Tcorsr ,+-%o_Bozeh-Me icngov_Pegadena 8. Said attorncy requests 1 fce of $ 200_ 0_ QO_ Amount of attorney fee previously if any, $ None 9 Reason for CompromiseA dlspute efists.88-Z0_the_reolduala_n2_che_Applicane In:-cerzan dl98bfli.{es xrc cha parov93 mave ned c22 s&vicq 02 che SaEerral rREIRz 0Z 6h2_Apreale_Boari_and thil_bs_Prmardly_predicated_WpcR_A cpopoolae-betten tba Varicus rarfn83 4.l parcles deaire to Bwo3d che hazerdo o2 lieiboeic] e5d S0_daferndonc_dealze ~buy_ttolr_paace 10_ The undersigned rcqucst that this' Compromise Agrecment and Release be approved. 11. Upon approval 0f this Compromise Agreement by the Workmen'$ `Compensation Appeals Board or 2 Rcferee; and paymect in accordance with che provisions hercof, saic cmployee rcleascs and forever discharges said employcr and insurance carrier frorn 1ll clain:s and causes of gction, whethcr now known or ascertained, Or which may hercafter arisc or develop as 1 result of said injurz: including any &d all liability of said employcr and said insurance carrier and each 'of them TO the dependents, heirs, executor: representativcs, administrators or assigns of said employec 12_ It'is agreed by all parties hereto that the of this document is the of an application on behalf of the employee, and that thc W.CA.B may in its discretion set the matter for hearing as a regular tion, reserving to the the right to put in issue any of the facts admicted hcrein, and that if hearing is held with this document used as an pplication the defendants shzll have available to them all defenses that were available a5 of the datc of of this document, and that the W.CA.B m} thereafter either approve said Compromise Agreement and Release or disapprove the same and issue Findings and Award after hearing has been held and thc matccr regularly submitted for dccision. 13_ For the purpose of dctermining the lien claim fcd herein for the uncmployment compensation disability bencfits vhich hive bcen under Or pursuant to the California Unemployment Insurance Code; the parties propose the following division of the sum upon for settlement and release of this casc: for temporary disability covering the ~for accrued medical expense or incurred by the employec: for future medical care. for permanent disability. (The above scgregaticn must hc fair-and rcasoablc and must be based on thc real facts of the case. Thcre should be no attempt made to cleprivc thc lien climant of 7 rcasonabk: recovery consistent with all the amounts involved )` WITNEsS the signaturc bercof tbis_ 12 of Moxek 19_ 68,at Pasadanss_CaliEoxnle: AAla: Liker siDRAN ETEEAn / Agplleant Byz 22 32_3 EABEK TEUEIR , aetya Zor Appllaeet MTNESEED ALIPELLZGH CCSI.CTzow CeMPaTZ Thc INJURED'RPPlicanT'6 SIGNA URE Mu3t DE ^tTESTED DY Two DIsINTERESTED PERSONS OR ACKNOWLEDGED BEFORE Notany Fublic ABEONNI RAESZ_CCRIEANY XcLAUSNZJEA 570w3, DALBEX & Cur3izw STATE OF CALIFORNIA Ry ~nx} SS_ Jona 8 0 lieLaughli0 County ofLos_Ange GA On this 12cko - of Magch AD. before me, Ehe_uaderEianed 0 Notary Public in. and for the said County and State, residing thcrein, duly commissioned and sworm bersonally Sicban-Bb-S*xben- Ra# to w€ to be !be 'brrson_ whosc "a"c a/'rie to !kr' witbin Imstrumeet, ael #keen Icdtgel to mc tbt b:'._ eecutcd the somc_ I~ H"Nsc.1"./#08, irrruule Srt Lun J"]l #fited m> eficinl sal thc #1 srar m} Ibic Crrtifast frst Jh: #{_ 3k AN Notsr} Publir in JMl |ot sid Cgunl; 4uJStol ' 1706 1^ |i:4n ny 5 4":5 ; Gri" 6t Forne5i Yiosm 431 9348 27 9.$; 44 J 8 paid, filing filing applica parties filing agrced paid period _ paid ~dey tz; 1958 day aphcer b!? d#y #) ================================================== Page 40 ================================================== McLAUGHLIN, EvANS, DALBEY & CUMMING ATTORNEYS AT LAW JOMN McLAUGALIN AREA' CODE 2'3 BaRRY EVANS 1717 NORTh HIGAlAND AVENUE, SUITE 710 TELEPRONE WM. 8LA R DALBEY RAY 8_ CUMMinG Los ANGELES, CALIFORNIA 90028 466-8541 AAROLO BENNETT NED GAYLORD JOAN BARTOS EORGE R. KASWELL FLLAN R SCAURMER RobERT H. GILLAAM March 10 , 1968 Argonaut Insurance Copany 443 Shatto Place Los Angeles ) California ATTENTION : J D Stiner Glaims Examiner RE : Claim Number: 02X-203445 Sirhan Sirban Vs Altfillich Construction Company; Inc . Dear Sirs : The above atter came on for further before Referee Ernest Lachmann at Los geles on February th of 1968 _ The applicant was present and represented by his attorney_ The issues were: Disability Apportionment '3) Lien clein 0f the Various doc tors 6) Reimbursenent under 4600 of the Labor Code 5 Need for further medical treatment Setclement negociations were undertaken at the suggestion of the Referee and &n offer 0f settlement Was made at the sum of $2 500 00 which after; consultation wich your company , was rejecced_ 0 The tatter was then taken at the Referee S suggestion to the Permauent Disability Rating Bureau where the Permanent Disability Rating Expert, Daniel Lucien rated the matter at 1%6 for the scar on the chin and the eyes on the report of your doctox Dr . Albori, anc upon Dc Yamshon S report, the case rated i5% the 1% or a total of 167 After further settlement negotiations } it was finally egreed to settle he case for the sum 0f S2 ,000,00_ The applicant apparently is still being treated by Dr _ Kiehn to Thon your company sent hin for an examination and who ~pperenely continued *0 treat him. It was agreed that we Wou:Id 2sSeiille in &ddition *0 the 82,000 the emount of the doctor S 707 hearing_ An plug Q0 , ================================================== Page 41 ================================================== Argonaut Insurance Company Page Two March 10 1968 ATTSNTION = J D. Stiner RE: STRHAN SIRHAN bil1 This was discussed with your Miss Jean Stiner and based upon the recomendation 0f this` office and concurrence of your company , it Was agreed to setcle the case for $2,000 .00_ Very truly yours 9 Mc IAUGIILIN EVANS 9 DALBEY & CUMMING By Johr F Mc Laughlin JFM ic 703 ================================================== Page 42 ================================================== G0 RDO N M. D EYE PKYSICIAN # SURGEON 48 NoRTH EL Molino AVE., PASAOENA, CALIFORNIA $ 118 REG_ NO 2423 TEL. 449.6494 CALIFORNIA STATE LICENSE No. 0.A-14163, Argonaut Insurance Companies 1001 Wilshire Blvd _ Los Angeles, Calffornia Re : Mr 0 Sirhan Sirhan DETACH AND RETURN Tkis Portion With YoUR REMITTANCE CANCELLED CHECK 15 YOUR RECEIPT DATE R.Vs; SERVICE CODE FEES CREDITS BALANCE PRSVIOUS DALANCE 10-27-67 5400 $27 50 10-27-67 0001 16050 11-10-67 900b 5 . 50 11-17-67 9004 5050 11-26.67 9004 5 . 50 12-6267 900b 5 , 50 12-11-67 9004 5 . 50 12-18-67 9006 5.50 1-2-68 9004 5. 50 1-16-68 9004 5 , 50 1-23-68 9006 5050 11-3-67 9006 5 , 50 899.00 4 4| E. GORDON KIEHN, MD_ PAY LaoT AKOUNT IN 48 NoRTH EL MoLIno AvE., PASADENA, CALIFORNIA 91O1 ThIG COLUMN EXPLANATION OF SERVICE CODE: 90OO Initiol Office Visif SURGERY 5630 Refina Reattachment 9001 Initial Office : Diognostic 5420 Goniotomy 5641 Muscle Surgery 9024 Relurn Visit-Treatment 5421 Enucleation 569 IRD Lid Abcess 9005 Office Visit, Special 5431 Suture of Globc 5702 Chelazion 9010 Home Visit 5448 Foreign Body Rcmoval 5727 Blopharoptosis 9014 Follow Up Home Visit Corned under Slif Lamp 5730 Cautery Puncture ReBairopion 9020 Initial Hospital Visi; 5457' Ptcrygium 5731 Ectropion Ropair 9024 Follow Up Hospital Visit 5472 Korctoplasty Penetroting 5732 Entropion Repair 9374 Office Visit, Night Holiday 5481 Suture of Perf Cornea 5743 Suturo of Corjunctiva 9029 Consultation 5491 I0 Foreign Body 5753 Excisicn Conj Losion 9031 Consultation by Report 5495 Ecieecio: gclcoforei Posterior 5775 Conj: Flap Operation 5420 Eye Exam Refraction E521 Repair Sclera Wound 5821 Cath. Nasolacrima/ 5402 Gonioscopy 5541 Excision Lesion Duct 5406 Orthoptic Evaluation 5544 Irideclomy 5831 Plastic Repair of 5408 Visual Fields 5561 Repair' Prolapscd Iris Canalicula 5409 Tonography 5571 Iridencleisis 5833 Dacryocystorrhinostomy 5410 Glaucoma Provocative_ 5580 Cyclodiathermy 5846 Probing of Mydriatic Sfudy 5582 Cyclodialysis of Canaliculus 5412 Fifting Contaci Lenses 561 Cataract Extraction 6993 Assist af Surgery RVS column for Insurancc Purposes Only 703 L JEHN, (3 E3C2] Hu ~Dk / 3 &u (Lh ris Irrig_ ================================================== Page 43 ================================================== doctor'S FIMAL (OR MoNTHLY ) REpoRT AND: BILL Itemized bills, IN DUPLICATE, are to be submitted a} #he terminarion of the case. Monthly statements aro POSITIVELY required on casos urder freafment, Mail *o Argonaut__Insurance Cqupenies Address_LOOL WILshire_ Blvde LeA Services beginning late in month and extending into succeeding month may be itemized on one statement. EMPLOYER Altfillisch Const 0 Company EMPLOYEE Mr Sirhan Sirhhan DATE OF INJURY_ 9-24266_ SERVICES FOR MONTH OFJ0.1112-67 1-680 Pafien? rerfused treatment Patien} able *o return to work 19 Patient stopped treetment Pafient discharged 8$ 19 without orders 19_ Condition af time of last visit See attached_report. Patient enrered hospital 19 other charges auxhorized such as 7 Hospital?_ (Chock) (Check) Code: O_Officc; V_-Home Visix; H_Hospital Visit; N-_Night Visit; $_Operation; X_X-Ray; Month 2| 3 4 5 6 | 7| 8 9 10 i1 12 13 14 15 16 17 18 19 20/ 21 22 23 24| 25 26| 27 28| 29| 30 31 OcE_ 624 NoYe624_ 0 0 DeCa Jano 68 Totals First aid #reatment (describe) Office Visits Please see_ attached billing Kome Visits_ Hospital Visits_ Operations MATERIAL (Itemized a} cos})_ TOTAL $ $99.00 charges shown above which are in excess of tho minimum fee must be explained below rogarding naxure of such services, indicating She date rendered. Mate check {o: DocforE 0 Gordon_Kiehn, MoDo Signafure_ Address_ 48 N o El Molino Ave Suite 203 Datc_ 2-15-68 Pasadena 9 Californie 91131 710 Sezanzi 3.*X i;:ic 1.4' ii Forrn 0.Ik cured_ Any Druss Any Payable ================================================== Page 44 ================================================== E. Gordlon Kiehn, MD Suite 203 48 NuRik EL NOLINO AVENUE PASADENA, CALIFORNIA 9m101 TELEPAONE 449-6494 February 15, 1968 Argonaut Insurance Companies 1001 Wilshire Blvd Los Angeles , California Re : Mr Sirhan Sirhan Gentlenen: Thank you for the reports of Dr. Tashna and others regarding this Interesting patiento I Iust ednit chat I vill have to agree with Dr , Tashma regard the functional overley in thls particular ent, However in re- checking him and seeing what his situation was I found that he had a loss` of accomodative power in the left eye of epproximately two to three diopters. I felt that possibly some of the pa in in the left eye Mas due to 3 spasm of &ccomodation and in order to test this out I placed him on drops of Hyocine #7. When it was found that this indeed he lped his I placed him on this, putting 2 in at weekly intervals and then stopping the drop and seeing how he got along His Mas relieved a great deal but recently he has again started having a little bit of it S0 he was Placed on another of Hyocine I think that the time interval between drops is gtadually decreasing and It should nol be Jong before he would be completely off of chat medication The small tight band towerd the inner part of the eyelid in the epicenthal fold 1s a problen apparently which bothers him but which I have been unable to really adequately evaluale. It is difficult to separate that which is functional and that which is real in this patiento I would suggest that in order to b2 absolutely sure it might be mel3 for him to see an ophthalmic Plestic surgeon, someone like Dr . Hartnan in Los Ange les, 1 trust this Fiil give you an interim report on this patient, and I am hoping that soon he wiil be able to back to worko Sincerely, E, Gordon Kiehn, Mo Do EGK:ra Encl Patie ing pain drop Pain drop get 4,7Y` 711 ================================================== Page 45 ================================================== TO 3 SUBJECT Z DATE 2-23-2 72031 4 67 17Ae Lb iAeA' 46Z 42Q @ RSPNAUT INSURANCE PLEASE REPZY To SIGNED Use Reverse Side Yowr Reply GEN_ SO8R2 At 712 5_22AA_ ================================================== Page 46 ================================================== EARZ M, LafFoon INVESTIGATIONS 1833 WEST 8TH STREET SUITE 210 Los ANGELES, CALIFORNIA 90057 HUbkerd 3-6943 INVOICE #: 208-4503 ATeuttttnttt Argonaut Insurance Company 443 Shatto Place DATE: February 2, 1968 Los Angeles , Celifornia DATE YORKED_1/26_25/68 CASEs RE: S IRHAN B_ S IRHAN VS Altfillish Construction Co CLeIM A'o: 2x 203445 L-3191 113 houRS-DAY Of SuRveilLAnce AT 88 Pea DAY-Rcu? 92 .00 KOURS-DAY OF investigation AT PER DAY_#w? MAG,ROLLs 1Gmm EaStMAn a2w Film AT BC+e MA G.RoLls Of 1gmm KooACKROXE Film At 810 6oly $ 10.00 COURT OR M.C.A.B. MEARING OtheR 14 minimun car expense S9/ay 13.50 days ) Offiae RzPense CENITS P2R Mile 6 00 EXPZNSES: RoTe_ M, (_ees TElEPXON:_ .90 ne4ewALI FEB 1 3 Ige8 Ju- L' MENS 238761 CHK No, PAm XS "EzS axounT, TiystatsGtksc: 3iz0 4o 3 122 40 JorAl71.3- J . ( Thank Ycwa? 4 / '1048 of 2 eaCck Gal ================================================== Page 47 ================================================== EarL H, LAFFOON INVESTIGATIONS 1833 WEST 8th STREET 5 Suite 210 LOS ANGELES, CALIFORNIA 90057 HUbbard 3-6943 208-4538 INVOICE #: O7At Argonaut Insurance Company 443 Shatto Place Date: February 7, 1968 Los Angeles , California DA TE HorkED_ 2/768 CAsg S IRHAN B SIRHAN VS Altfillish Const _ Co _ CLAI NO: 2x 203445 L-3191 hours-DAY Gf Surveillane Pex DAY_#ov? KourS-DAY Of INVESTigation At Pe? DAY_KouR Mag,RolLS 0f 1GMM EASTKAN 88w Film AT CCX MA 6.RolLs OF i6Mm KodacKROME Film AT EOL 45.00 Court OR W.C.A.B. KEARING OtheR office expense 1.50 KAILES AT CENTS Pz? KilLe EXPENSES: KoT}l_ YELCPMONZ_ MEAIS_ PARXIA?: TzES__ L5O 1.50 7 JOZAL. $ 48 . 00 Thork You! ================================================== Page 48 ================================================== FRU SH ZONE NO. ~LAIA{ NO . 7 X Zsisys 4SSURED LezLEs_i RESERVE CLAIMANT EXAMINER DELIVER To' DATE & TIME REQ. NOT FOUND BY Notify REQUESTING EXAMINER , NOTES: ' 7 nU # Merlz' 7,6-+-0 715" ClM ================================================== Page 49 ================================================== RU S H ZONE NO. CLAIM No_ AK-ZoasLXS ASSURED Cexhel RESERVE CLAIMANT LiL_ EXAMINER zK 2/ DELIVER DATE & TIME REQ. 2-2-68 IF NOT FOUND BY NotiFY REQUESTING EXAMINER NOTES: ~ Hu/qz a7l e T 09p3k677 #NEEZ ReY WEtaehete lnl0 RcLJiriul KU 2n 716 :lM-206i Y82. @hHuuuibs , dAAdtes GUs ================================================== Page 50 ================================================== ARGONAUT INSURANCE To FROM ZSDATE_ -19_ 7 INJURED_ PoLIcY INSURED_ POLICY TERM CONVERSATION witx CLAIM #_ 223 44 5 76F6 45_06_ 2a_ EZEzL ClK 547 R-1 l Ss Wet

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