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File: 092396_aug96_decls14_0003.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
@5:47-12@ PATIENT F TLE 12/@@9/90
PERSONAL DATA - PRIVACY ACT OF 1914
5 U.S.C. 552 (b)(6)
I'@. .410D@r: A
NAME; 18, AUTLIDRITY #-. 036OA036 2, SSAN: 3. PRECEDENCE: P,
4. STAT: All 5. GRADc'! '@4 6. AGE: 27Y 7. SEX: F 8. @4T@ 128 9. READY DATE: 360
10. ISO: Al. FORT 12. SPEC CAT:
14. REAS RE'U: DS 15. DAE LAST VISIT: 16. CLASS: IC
AT
17. ACCEPT 11 YS: 19. APPT/StJRG DATE: NO
20. APPRC@V AUTH: 21. CAN'@/I.NC: 22. VALID: TJH Y9
23, MTF ORIG: A51@@o USA DISPENSARY DHAHRAN 24.TCAD ODIG: OEDR
25. MTF DEST: F5070 USAFRMC WIESBADEN GE 26. ICAO DEST: EDAF
27. iviED SPEC 1: MPPG 26@ DIAG l@ 3f)89 UNSPECIFIED ACUTE REACTION TO STRESS
29. TIED SPEC 2: 30, DIAS 2:
31. iviED SPEC 3: @2. DIAG 3:
32A. PROCEDURE:
@-3. SPEC DIET: N/ 34. IV:
35, 02/LPM: N 36. SUCT-N 37. X-6 TUBE; N' 38. RESP: N 39. FOLEY: tv! 40. STRYKER: N
41. INCUB: N 42, TRACT: N 43, IMED: iN 44. CAST/LOC: N 45@ TRAC4: N 46. rt,,IN: N
73. PT BAG WT:
47. SUPP INFO: HF@C 7TH CORPS DURHAM NC P"T AT O@5 EV
AD, REPORT-CD BY SUB-JriRO
48. MAX ENRTF STOPSI Y 9 49. MAX # RONS: Y / 9 50. ALT REST/MAX HT@ i%'
53@ INPATIENT: Y 54. SPEC PROG: VA DRUG ALCOHOL WT NONE X 55. VA PIODE-,
56. ADMIiN/CVc'RSEAS.
58. VITAL SIGNS(TEMP/FULSE' 'RESP/DLODD PRESS)I 097.4 72 / i6 / 100 80
57, Hf@D: 60. HCT: 61@ AEG: DATE TAKEN@
62. t4BCi 63. SI/VSI: 64. MEDICATIONS: VALIUM PP.@l
65. qlSi DRY: PRESENTS @ITH INADI'@Iiy TO SLEEP, CON--USI@N, UNABLE TO EAT,
CRYING gPt-:LLS.
66. ATT PHYST STONEFIELD 67@ P@4#: 000 000 OOAIO 68. WARD#/PH#: 000 / 000 000 0000
69, REPORTED BY: TSOT ROBINSON 70. PP@#; 000 0000
74. ATTENDANT NAME #I: 75. STATUS: 76. GRADEI
77. AGE: 76, SEX: 78A,, W-1@: 79. RELATIONSHIP TO PATIENT:
80. BAG TYPE: Si@ BAG TAB 62. BAG WTi
03. ATTENDANT NAME #2: 84. SIATUS: 85. GRADE:
86, AGE: 87. SEX: 87A. @IT: 88. RELATIONSHIP TO PATIENT;
89. BAG TPE: 90, BAG TAG 91. BAG WT:
ly
92. TRANS DRIG PHONE EXT:
93. TRANS DEST PHONE #s EXT:
94. ETA CRIB MTF(n@ATE/TIME): 000 35. ET DEST ivTE(DA'E/T'ME): 000 I
@A
97. OTHER COMMENTS:
5i. IISN' #: 0000/360 52. RON LOM
57@ VALIDATED BY/REAS FOR HIGHER PRECEDENCE:
96. AIRCRAFT ITINERARY;
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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