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File: 092396_aug96_decls14_0001.txt
Subject: PATIENT FILE
Box ID: BX000482
Document Number: 2
Folder Title: MEDSTAT - SITREPS DEC 90 4 OF 6
Folder Seq #: 8
Unit: ARCENT
Parent Organzation: CENTCOM
C.-n 47 i 49 i:-Il@E '12/29/90
PERSONAL DATA - PRIVACY ACT OF 1974
5 U.S.C. 552 (b)(6)
A
1. NAME: 16. AUTHORITY #: O@-60A.026 2. SSANI: PRECEDENCE: R
4. ST T: All 5. GRADE: E04 6. AGE: 21Y 7. SEX: F S. WT@ 122 9. READY DATE: 60
@A
10. Isol 11. POR: 12. SPEC P.ATZ
'44. @REAS RES: DS 15. DATE LAST VISIT; 16. CLASS: 3A
i7. ACCEPT PHYS: JMRD 10. APPT/SUPG DATE. NO
20. A.@p@ROV AUTH; 21, @@ANCIIN'U: 22. VALID: T07H Y9
,3. MTF CRIG: A5150 USA DISPENSARY DHAHRAN 24. ICAD CRIG: DEDR
25@ Mi-IF D-@ST@ A5040 2ND Cc@14 @OSP LANDSTU41 26. !CAG DES@- FDAR
27, FicL SPEC 1; 83tq' 26, DI@1.6 i: 7242 LU BAGO
29. j'IED SPEC 2: SOD 30. DIAG 2i 724-', LUMBAGO
31, @IED SPEC @. 32. @.IAS 3:
32A. PROCEDURE:
33. SPEC DIET: N/ 34. IV@
40. STRYKER: N
41. INCUB: N 42. TRA'@T! iN 43. L@MED: i4' 44. CAST/LOC: N 4a. i@AC@: N 46. MGIN: N'
PT GAS TYPE: NB 72@ P' BAB TAG 73, PT BAG 'OT:
47@ SUPF INFO: HHC DISCOM; r'T. HOOD, TX REPORTED BY
47TV, FIELD/SUB AREA
48. ilAX ENRTE STO@OS@ Y / 9 49. IIAX # RUNS; Y 9 50. ALT RES7/MAX HT: N
53@ IN-PATIENT: Y 54, SPEC PRO@@T VA DRUG ALCOHOL @'T NONE X 5@@ VA @DE:
56. ADMIN/OVERSEAS:
58. VITAL S'r@NS(TEikiP/PULSc@/Rc@SP/BLOOD PRESS)@ 096.0 64 20 100 60
59. HGB: 60, HCT: 61@ ABB: DATE TAKEN:
6@'. WB'@@ 63. SI/VSI- 64. MEDICATIONS: MOTRIN 800MG TID
65. HTSTORY: HERNTATED DISP STARTED IN MAY 89; ADMITTED 26 n.P,T 90. SMALL SPUR AN
D ARTHRITIS IN L4 & L5. PT C/O CPRCN'P PAIN IN BACK 67\'Cc AMAY 69. NEEDS FURT
HER EVA'@.
66. ATTPHYS: CANTON, MAJ 67. PH#: 000 OA@o 0000 68. i4ARLI#/PH#: 000 000 O'vo 0000
69@ REPORTED BY@ DENTON 70. PH#: 000 0000
74. ATTENDANT #I: 7'0. ST US; 76. GRADPI
.AT
77. AGE: 79, SEX: 78A@ tqT: 79, RELATIONSHIP TO PATIENTI
WT:
83. ATTENDANT NAME #2: 84, STATUS: 95. GRADE:
26. AGE'T 87. SEX: 67A. WT: 8B. RELATIONSH TD T@ PATIENT:
89. BAB TYPE: 90, BAG TAG 91. BAB IIIT:
n
92. TRANS ORIS PHONE EXT:
93. TRANS DEST PHONE EXT:
94. ETA ORIG MTF(DATE/TIME): 000 95. ETA DES@ MTF(DATE/TIN-E)@ V'00
97, OTHER COMMENTS:
51, MSN #: 0000/361 52. RON LOC:
57. VALIDATED BY/REAS FOR HIGHER PRECEDENCE:
96@ AIRCRAFT !I TNERARY:
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Document 30 f:/Week-32/BX000482/MEDSTAT - SITREPS DEC 90 4 OF 6/patient file:09069614064231
Control Fields 17
File Room = aug96_declassified
File Cabinet = Week-32
Box ID = BX000482
Unit = ARCENT
Parent Organization = CENTCOM
Folder Title = MEDSTAT - SITREPS DEC 90 4 OF 6
Folder Seq # = 8
Subject = PATIENT FILE
Document Seq # = 31
Document Date =
Scan Date = 14-AUG-1996
Queued for Declassification = 01-JAN-1980
Short Term Referral = 01-JAN-1980
Long Term Referral = 01-JAN-1980
Permanent Referral = 01-JAN-1980
Non-Health Related Document = 01-JAN-1980
Declassified = 06-SEP-1996