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File: 092396_aug96_decls14_0008.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
li 70 :52 PATIENT FILE
uk7! PRIVACY Ar
PERSONAL @ A C@ 1974
5 U.S.C. 552 (b)(6) 1'.
NArIE: 18. AUTHORITY @'359AO'9 2. SSAN: 3. PRECEDENCE: R
4. STAT: All 5. GRADE: E@4 6. ABE: -N5Y 7. ScX@ M S. 'OT@ 16'j 9. READY DAiEi '@9
10. ,so: il. PORT i 11 12. SPEC CAT:
i4. REAS RES., DS 15. DATE LAST VISIT. 16. CLASS: 3A
17@ PHYS: J@.90 19. APPT/SURG DATE: NO
@o. APPROV AUTH: uANC/IENI,.; 22@ VALID: C@IH Y5
2@ K@F 2,R!S,@ PFj'i5O USA DISPENSARY DHAHRAN 24, IC@G gRlGt GEDR
25, @@YiT7 DEST- Aj'040 '@ND S@N HOS@D LAN'USIUHL 26. TCAO DEST: ED,AR
27, IMED SPEC 1: SSR 28, DIAG l@ ?951 BENIGN NEOPLASM. Or' CRANIAL i%',RVES
29. i@tED SPEC 2: 30. DIAG .1;
171@ rED SPEC 3: j2. DIAS 3:
32A. PROCEDURE@,
:
35. 02/LPi@- t@ 1 36. SUf-'T: ;%' '@i @ NS TUBE: N' 38. f -RP: N -N9. FOLEY: N, 40. STRYYER- N
41. INCUB: N42. TRACT: N 43. N 44. C.AST/LO@ @4 45. TRACH; N 46. rDN: N
71. PT BAG TYPE: NB 70, PT BAG TAG 7'. PT BAG WT:
47, SUPP 3115 7'kH CORDS LANDSTUHL F@NT AT FLT q@
, REPORTED BY SUB-JMRO
48. IAX E@iRT@, STO@-I Y 9 49. iM,4X # RUNS- 't 9 50. ALT qT- N
53. INPATIENT: Y 54. SPEC PROB: VA DRUG ALCOHOL @,'T NONE v 5'.. VA CODE:
56, ADMI,'4/OVERSEAS:
58. VITAL SIONS(TEMP/DULSE/RESP/BLGOD PRESS): 098,6 75 12 li6 72
61. APB:
J9. HGB; 60. HCT: DATE TAKEN:
WBC,, 67.. SI/VSI-. 64.
6@@. HISTORY: HEARING LOSS X 2 YRS@ NDt4 HAS DIZ71NESO AND LOSS OF BALANCE.
PREVIOUSLY EVALUATED FOR POSSIBLE Tl.",It@OR. NEEDS FURTHER @-VA@ OUT OF AOR,
66, ATT PHYS: PARKER 67. Pu#: 000 000 0000 68@ WARD4@/PH#: 000 / 000 000 0000
69. REPORTED BY: TSBT ROBINSON 70. N.#: O@@o 0000
74. AT TENDAN7 NAME 75. STATUS: 76. GRADE:
78. SEXI 78A. @4T: 77. RELATIONSHIP TO PATIENT:
60. BAG TYPE, 61. BAG 'AG 82, BAG @,T@
87, ATTENDANT NAi@E #2: 24@ STATUS: 85. GRADE:
86, ABF,@ 87. SEvi 67A. @T,. SP,. RELATIONSHIP TO P@i ENT:
89, BAG TYPE: 90. BAG TAG 71. BAG WT:
@2, TRANS BRIS PHONE EXT!.
93, TRANS DEST PHONE #i EX):
94, ETA. ORIS jyiTF(DATE/T IME)I 000 1 95, @c-l@A D@'S' MTF(DATE/'T.@,E): 000
97. OTHER tltl,@,ENTS:
@@l, "iSi@ #@ 000'v/359 @@2. RON LOC!
57, VA.'@IDAT---D BY/REAS FOR H16HER PRP-CEC@ENCE:
96, A-.-RCR.AF TITI,@iERARY@
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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