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File: 092396_aug96_decls14_0006.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
PATIENT FILE 12129/90
-90i@AL DATA @y OF 1974
PE@ - PRIVA@ ACT
5 U.S.C. 552 (b)(6) ,'@,ODE@ A
1. NAME 18, AUTHORITY 4@: 07@61AOO4 2. SSA@N.: 3. PRECEDENCE: R
4@ STATT All 5. GRAD@-2 E06 6. AGE: 44Y 7, SEX! @M 8@ WT: 150 9. READY DATF-I 361
10. ISG-@ 11, PcRt 12. SPEC C@T,. It
14. REAS REG: DS 15. DATE LAST VISIT; 16. CLASS@ IC
17. ACCEPT PHYS@ 19. APPT/SL'RG DATE: t,@O
R
40@ AP;, OV AUTH: 21. CAN'C/IN@@: 22. VALID: L@NK I Y@.
23, MTF DRIS: A5150 LISA DISPENSARY DHAHRAN 24. I@@AO GRIG: O,F-DR
25. MTr- DEST: F3070 USAFRYC WIESDA EN GE 26. ICAO DEST: EDAF
AD
27. MFD SPEC 1: MPPO l@8. DIAG 1: 71083 OTHER ACUTE REACTIONS TO STRESS
29. i@@D SPEC 2- 3@l. DIAS 'L.
EC 3: 32. DIAG 3@
32A. PROCEDURE:
33. SPEC DIET: 34. V!
35@ 02/LPV@; @4' 36. SUIT: N 37. MG TUBE: ti 38. RESP; @4 39. FOLEY: N- 40. STRYKER: N
41@. Ij'4CUB; @N' 42. TRACT: i,4' 43. Ir,-ED: N 44. CAST/LO@,@ N 45@ TRA@@H: @4 46. riO@N: N
71. PT BAB TYPE: N-B 72@ PT BAG TAG 73. PT BAB W'@
47. SlrrP INFG- 296TH TRANS @@, BK05K4AvEN, ,is /1173 YiROll
//85 EVAC//
48. MAX PNRTE STOPS: Y / 9 49. MAX # RONS: Y / 9 50, ALT REST/MAX F.T: N
5@'. INPATIENT: Y 54. SP_PC PRO(ii VA DRUG A'@CML t4T t@lo@Xlp y 55. VA CODEI
56. ADMIN/GV-tRSEAc@:
58. VITAL SIGNS(TE@iP/PULgc@"REEP/BLOOD P@RESS): 099.8 / 76 / 1.0 '26 84
59. HGB: LO. HOT: 61. ABS.- I DAT TAKE,%':
@E
62. Wl,;C: 67@. SIIVSI! 64. MEDICATIONS: NONE
65, HISTORY: POSTRAURATIC STRESS DISORDER, VIETNAM VET ;41TH FLA.SHDAP@.kS, DENIES 6
UIP@TDE TEND' '!'
zN@ aS@
66. AT-i OHYS: STONIEFIELD 67. PH#: 99? 099 9999 68. @;ARD#/PH#: 999 999 99V 9?99
69. REPOPF@D BY: 681 ABBOTT 70. PP@4@t 999 9999
T NAME #I: 75. STATUS. 76. GRADE:
71. AGc@; 76. SEXG 78A. WTi 79. RELATIONSHIP TO PATIENT:
80@ BAG TYPE: 81. BAB TAG 92. BAG WT:
83. AITFNDANT NAME #2: 64, STATUS: 85, CRADET
@6. AGE: 87. SEX: 67A. t4T: 88, RELATIONSHIP TO PATIENT:
89. BAB TYPE- 90. BAB TAG 91. BAG WT:
92. TRANS ORIS PHONE
0 .T ANS DEST PHONE EXT;
,3 @R
94. ETA ORIS MTF(DATE/TlriE): 000 95. ETA DEST @liF(DATEI'TTiv.E): 000 J
97@ OTHER COMMF-@ktTS-
5'. .',!.SN #: OC'VO/361 @,2. RON
57. VALIDATED BY]WCAS FOP PRECEDENCE: 1
96. AIRCRA@ ITINERARY:
PT
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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