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File: 092396_aug96_decls28_0003.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
05:49:4;,, **** PPJlEtN'T FILE **** '2/@49/90
PERSONAL DATA - PRIVACY AC, OF 1974
5 U.S.C. 552 (b)(6) '3.
NAME: 18. AUTU RTTY 036IAO4'@ 2. BSA' 3. PRECEDENCE: R
lio
4: STAT: All GRADE: c,04 6. AGE: 24Y 7. SEX: M, B. 1,@JT: 19',) 7. READY DATE: 361
10. I i PDR.
I'. SPEC '-'AT.
14. n'- AS REG: DS i5. DATE LAST VISIT: 16, CLASS: 3A
c
17. ACCEPT PHYS: J.'IRD 19. APPTIS'.'RO DATE; NO
20. APPRC@V F@UTH: 21. CAN'L/I,\'C: VALID: TJH Y9
23. ',@@TI: ORIG: A5!50 USA DISPENSARY @,F@AF@'RAN' 24. IP,A@@ OR@6: OEDR
DEST: EDAF
,5. ,TF DEBT: FJO70 USAFRM@P@ Wic@SBADE@N GE 26. TCAG
REITER'S DISEASE
29. NED SFEC 2. 30. DIAS 2:
31. t@iED SPEC 3: 32. DIAS 3:
30@A. PROCEDURE;
37, SPEC D TC7@ N/ 34. TV:
75@ n /LPri: N, 36. El-CT: N 37. N@P TUBE; ti 36. RESP: N FOLEY: N 40. STRYKER:
,2 09
41, INICUB: t@' 42. TRACT: -N 43, -i@lc@D: N 44. P@AST/LOC: N 45. TRACHI N 46. tICIiN: iN
71. PT BAB TY E: N,@ 72@ PT BAG TAG 771. P' BAB L@T:
47. SUPP INFO: 26 @',AINT CO 'T -@AP@PEEL", KY/141-T.H ET,@LDI/
Is. MAX ENPTE STOPS: Y 9 49@ MAX 9 RONS; Y 9 50. ALT REST/l,@AX HT: N
53. INPATIENT@ Y 54. SPEC FRCS: VA DRUG ALCOHOL 'OT NON--- X 5:-i. VA CODE:
56. ADmaTN'/GVERSEAS:
58. VITAL SIGNS(TEtIP/PULSE/RESP/BiOOD PRESS)@ 098.6 68 16 110 70
59. HG@l: 60,. HP@T,. 6'L. AEG- DATE TAKEN:
6". NBC: 63. Si/VSI: 64. MEDICATIONS: NONE
6'@. HISTORY: FISTORL OF PEIIERS SYNDROME TIMES " MONTHS - NO RESPONSE TO MEDS
66. A-IT PHYS; PI-ACE 67. P@q#: O(,'O CJOO "IOOCI 60. @AARr.,#/PH#t 00(@ / O@)O 000 0000
OC'O 0000
,4. ATTENDANT INANE #1: 75. STATUS: 76@ GRADE:
77. A@uE-. 72. SEXW 78A. 'c;T@ 79. RELATIONSHIP TO PATIENT:
80. BAG TYPE: 81. BAG TAG 82. BAG 14T.
87. ATTENDANT NAME 4n4: SA. STATUS: 85@ ORAD'A@
86. ABE: 87. SEXI 87A@ tqT: 88. RELATIONSHIP TO PATIENT:
89. DAB TYPE: 90. BAG TAG 91. BAB Wi@
9@@'. TRANS ORIG PHONE #: -_- 1:
Xi
9@= TRANS DEBT PHONE EXT:
94. ETA OR'G t@]-F(DATE/-;-IM-t): 000 95. @TA DEST MTF@DAjE/T!M'c): 000
97. OTHER COMMENTS:
51, #i 0000/361 501. RON LOC:
57. VALIDATED BYIREA.6 FOR HIGHER PRECEDENCE:
96. AIRCRAFT ITINERARY: 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