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File: 092396_aug96_decls14_0002.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
1
PATIENT FILE '2/29190
PERSONAL DAT - PRIVACY ACT OF '974
,A I 1
5 U.S.C. 552 (b) (6) 13. MODE; A
'B. AUTHORITY #: 036IAOO5 2. SSA',i; 3. PRECEDENCE: R
I. NAME: T
4. STAI@ All 5. GRADE: ;704 6. AGE! 25Y 7. SEX: iyj 8. @IT: 20@) 9. READY DATE; 361
ISO:
11. POR: 12. SPEC CAT:
'4. REAS RES@ DS 1-@. DATE LAST VISIT:
I 16. CLASS: 3A
17. ACCEPT PHYS: 19. APPT/SL!RG DATE: NO
20. APFROV AUTH: 21. r,ANIC/INC: @@2. VALID; LMK 1 Yo.
271. ',ITF ORIG: A5150 USA DISPENSARY DHAHRAN 24@ ICAD ORIE: DEDR
25. MJTF DES": F5070 USAFR@',C WIESBADEN GE 26. ICA DEST@ EDAF
27. rED SPEC 1: SOD 26. DIAS 1: 71763 OLD DISRUPTION OF AN'IERIOR CRUCIATE LIGAMENT
29. rED SPEC 2: 30. DIAS 2:
@l@ ?,ED SPEC 3: 32. DIAS 3:
32A. PROCEDURE:
33. SPEC DIETI N/ 34. IV:
35. 02/1@PM: N 36. SUCT: t%l 37, N-6 TaP-@. N 38, RESP: N 39. FOLEY: N 40. STPYKERI N
41. IN'UU@ @,N 42. TRACT: @i' 43. N 44. @IAST/LOC: N 1 45. TRACH.: N 46. MON: N
71, PT DAG TYPE-. NB 72. PT BAG TAG 41: 73, PT BAB @IT:
47. BURP 'i\'FO@ 172 TRANS @@oV@PANY, NB //173 PIRO//
/165 EVAC//
48. MAX EI%'RTE STN@PS, Y ' 9 49. MAX 4 ROINS: Y / 9 30. ALT REST/MAY HT-. N
53, INPATIENT: Y 54. SPEC PROS: VA DRUG ALCOHOL t@.'T NONE X 55, VA CODET
56. ADMIN/OVERSEAS:
q c @D .@'R-cSg): 098.0 11 90 / IS 110 70
@e. VITA'. SIGiN'S(i.MP/P'U'LSE/RESP"DLon
17. @q3B: 60. HCT: 61. ABS., DATE ;A@,EN@
62@ WBC: 63. SIIVSI: 64. MEDICATIONS: NONE
65. HISTORY: NEEDS RECONTRUC[ION OF Lcl@-I KNC@E, EXIENSIVE REHAB REQUIRED. INJURE
D LEFT KNEE X 3 WKS AT ALATOBE SAUDI ARABIA. HAD ARTHROSR@OPY 21 DEC WT TH ill
I
i@l MINESR,OPY.
66. ATT PHYS: GENNAO 67. P@H#: 997 999 9999 68. -',4.ARD#/PH#: 99? 999 999 9999
REPORTED D.Y@ SOT ABBOT , . pH#; 990 9999
.T
,4, ATTENDANT NAME #I: 75. STATUS: 76. GRADE:
77. AGE: 76. SEX: 70A. 'i4T: 79. RELATIONSHIP TO PATIENT:
30. BAB TYPE; 81. DAG TAG 4; 82. BAG @,'T:
83. ATTENDANT NAME #2: 64. STATUS; F.. GRADE:
86. ABE: 97. SEX: 67A. 'AT: 88. RELATIONSHIP TO PATIc,,NT@
89. BAB TYPE: 90. SAO TP.G-#: 91. BAB WT:
92. 7 ANS OR TS PHONE 'CXT:
IR
93. TRANS DEST PHONE il: EXT:
94. ET, ORIS MTF(DATE/Tl'ilc): 000 05. ETA DEST @iTF(DATE/Tii@E): O'vo
@A 1
97. OTHER CCi4V@ENITS@
51. MEN #: 0000/361 52. RON LOC:
57@ VALIDATED BY/REAS FOR HIGHER PRECEDEN----E@
96, AIRCRAFT !TIN@-RARY9 I
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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