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File: 092396_aug96_decls14_0004.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
40 4@@ PATIENT FILE
PERSONAL DATA - PRIVACY ACT OF '@974
5 U.S.C. 552 (b)(6)
13. tIODcl: A
I. NAME: 18. AUTHORITY #- O-,60AO50 1. BSA
@IN PRECEDENCE: R
4, SIAT: Ail 5. GRADE: E03 6. AGE: 20Y 7. SEX: M WT@ 180 9@ @@EADY DATE: '60
ISO-@ II. park. I 12. SPEC CAT-. I
14@ RE.AS RES, DS 15. DATE LAST VISIT: 16. CLASS: 3A
17. ACCEPT PHYS! 19. P.PPT/SURG DATE: NO
20. APPROV AUTH- 21. CA"C/INP@: 22. VALID: TJH Y5
23. MTF DRIG: A5150 USA DISPENSARY DHAHRAN 24. ICAIO ORIS. ri R
2@'. @ITF DEBT: F@@070 LISAFRMC WIESBADEN GE 26. !CAO DEST: EDAF
27@ ric,D SPEC 1: 28@ DTAG 1: --@682 DIPLOPIA
29. M.ED SPEC 2- ilri%l 30. DIAS 2- 3469 MICR@L'IE, UNSPECIFIED
31@ NED SPEC -11: 31@. DIAS 3;
32A. PROCEDURE:
34. IV:
3@@. 02/LPi@.: c / 36. SUET! %I 37, NO TUBE: N' 3@ RESP: N 39. FOLEY; N, 40. STRYKER: N
41. INCUB: N 42. TRAC I: i@' 43. I14,'cD: )N 44. CAST/LUC: N 45. TRA@114@ N 46. riON@ N
7',. PT BAro TYPE: NB 72. PT BAG TAB 73, PT BAG @i'T@
47. SUPP INFO: LANDSTUHL, SE //oil uly.RD/I
//Fi-EET 5//
48. jyjAX ENRTE STOPS: Y / 9 49. @@,AX # RUNS; Y / 9 50. ALI R'EST/@iAX Hla N
53. IMPATIENT: Y 54. SPEC PROS; VA DRUG ALCOHOL WT NONE X 5@-. VA CODET
56@ ADMIN/GV'cRSc,.AS:
58, VITAL SIONS(T M.D/PUI E/RESP' ' n P EBB): 098.6 60 / 16 / ILO '00
IE I-S IB@O@D R
59. HGB: 60. HCT: 61. ABB: IDATE TAKEN:
62. NBC: 61. SIIVSlz 64@ MEDICATIONS: MEtiRIN 25'@,'@18 ?RN; NATRlr-INI 25G,?,G -
275Vio 0.4 & 06@,' PRN'
b5. H.IST RY: PATIENT SUSTAINC HEAD liNJURY APP@ROX 24 DEC BUT PATIENT UNI@ i TO R
.ct ID ABLE
@CM@CMBER HOW. ADMITTED 24 DEC FOD DIP"CPIA A D MIER.4D..ES, SEND OUT C-' AOR FO
R @NEI-IR@Q EVAL. NOT FIT FOR DUTY.
66. AT PHYS@ ST UK 67. PH#: 999 999 7999 68, WARD#/Pw#: 999 f 999 993 99c;9
@T @q@
70. PH't; 999 9999
74. ATTENDANT NAME II: 75. STATUST 76. SRADP.-
77. AGE: 78@ SEX: 78A. i4T: 79. RELATIONSHIP TO PATIENITZ
80. BAD TYPE. 81. BAG iAg 82. RAG WT,.
83. ATTENDANT NAME #2: 84. STATUS: Bi. GRADE:
86. AS-a! 87. SEX: 87A. MT: 68. RELATIONSHIP 10 PAIIENT:
69. BAG TYFI@ 90. BAG TA@@ 91. BAS WT:
92. TRANS BRIG PHONE r@XT:
93, TRANS DEST PHONE EXT:
94. ETA CRIS MTF(DATEITI@jE): 000 95. ETA DEST MTF(D.ATE/TINIE)i 000
97. OTHER COMMENTS:
51. Y,,SJN #; 0000/36() 52. RON LOC:
57. VAL'DP.IED BY/REAS FOR HIS
,@,HER P'@'cL@EDENIP,E:
16. AIRCRAFT ITINERARY: 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