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File: 092396_aug96_decls28_0002.txt
Subject: PATIENT FILE
Box ID: BX000482
Document Number: 1
Folder Title: MEDSTAT - SITREPS DEC 90 4 OF 6
Folder Seq #: 8
Unit: ARCENT
Parent Organzation: CENTCOM
12/@4919@,
DA[IENT F T
PERSONAL DATA - PRIVACY ACT OF 1974
5 U.S.C. 552 (b)(6)
13. riODc: A
I @E 16. AJT
PRIORITY @: 036IAO35 SSAN 3, PRECEDENCE: R
4. STAT: All 5. GRADE: E@@)4 6. ASr@ 22Y 7. SEX@ B. WT@ 150 9. READY DATE- 362
10. ! SO @. 11. FOR,. I'L. SPEC CAT-@ 1
14, REAS RES: DS 15, DATE LAST VISIT@ 16. CLASS: 3A
17. ACCEPT PHYS: X,,,RO 19. APPT/Slt'RB DATE: NO
20. APPROV AUTH: 21. CA@%,C/IN'C: 22. VALID: LMK Y9
23. i@TF ORIS. A5150 USA DISPENSARY DPAPRA,K.@ 24. ICAD ORIG: OEDR
'ESDA.DEN GE 26. ICPO DEST: EDAF:
MTF DEST: r'@,070 USAFRM.C WT
27. M-FD SPEC 1- ririu 28. DIAL' 1: 49390 AST rA, 11 SPc !PED TYPE, STATUS ASTF,4iATICUS NOT
IC D
')9. @IEL, SPEC 2: 31), 'L)'A.6
31. TIED SPEC 3, 32= DIAS
32A. @ROCEDliRE;
,3. SPEC 'uic,T: N/ 34. TV:
@15. 02/LPMt iN 736. SU@@T: rl 37. NG TUBE- !%' "S. RESP: N 39, FOLEY: N 40. STRYKER: N
41. 7NCUB@ N 42. TRACT: N 4 @ !MED@ @N 44. t4 45@ TRAC@: N 46. nN: N
71, PT BAB TYPE: j',,,B 72. PT BAG TAG 73. PT BAG WT:
47. SUPP l'i4FC-- FT. @'.@EAD REPZRTED BY
4@, riP-@UIPT FROM @48 CSH
49. MAX ENRIE STOPS: Y 9 49. MAX # BONS: Y / ? 50. A'@T RESI/@'.AX HT: N
T@4PATIENT: [IT NONE X Si. VA CODE:
,Z ai Y 54= SPEC PROrj; VA DRUG ALCOHOL
56. ADri!N/GV,cRF@ASt
56. VTT ISlr@'i%S(TEiviP/PULSc@/RESP/BLOOD PDESS); 078.'o 95 / 24 120 70
@iA,
59@ HGB: 60@ HCT: 61, ADS: I DATE "KEN:
FM
61@. NBC: 67@. SIIVS!: 64. MEDICATIONS PR,)@-N'TAL INIP,,Lf'-ER, 2 PUFFS PR--
D@','iSONE, 60 MO PER DAY
65. DISTORY@ I YEAR HX OF ASTHMA. 46 HRS PRIOR To A jMISSTO@4, DIFFICULT BREATHIN
0 YESTERDAY. RECGt@MEi@'.DP-D OUT OF THE ADR. CANT TAKE PYRIDOSTIC!,IINE TABS TN E
VENT OF NBC ATTACK.
66. ATT PHYS: GARDNER b7. PH#-. 000 000 0000 68. WARD#IPH4: 000 000 ()C)O (,IOOO
69. P,-,@DOOTED BY, SBI rARCHA@,'T 70. P44.: 999 9999
74. ATTENDANT NAME 7". STATUS: 76. GRADEI
i7. ACE: 78. SEX! 78A. PE: 79. RELATIOT@SHIP TO PATIENT:
80.B TYPE@@ 81. BAB TAG 82. BAG WT:
93, ATTENDANT NAME @2: 84. STATUS: 85. CRADE-
86. AGE: 87. SEX: 87A. WT; 88. RELATI ONSHIP TO PATIE@NT:
89. BAG TYPE: 90. DAB TAG 91. BAB WT:
q2, TRANS ORIG PHONE EXT:
93. TRANS DEBT PHONE EXT@
94. ETA, 0.@RIG MTF(DATE/Ti,@iE): O',) 9i, ETA DEST MTF(DATE/Tl@ME)! 000
97. OTE-K COMMENTS.
51. vfSN #: 0000,1360@ 52. RON LOC4
5i. VALIDATED BY/Pc@AS '@IP HIGHER PRECEDENCE:
96, AIROIRACT IiINc@RARY: i 11 I
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Document 7 f:/Week-32/BX000482/MEDSTAT - SITREPS DEC 90 4 OF 6/patient file:0906961515157
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 # = 7
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