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File: 092396_aug96_decls28_0007.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
N.T
PA!IE I FILE i2/23/90
@uA@T - PRIVACY A@ U 1974
:A T
5 U.S.C. 552 (b)(6)
13, A
T-Y @f -
h' -. .. @RECEDENC-@ R
16. AUT OR C,7@61AO@@@, ;SAN:
7 A
4z ST fml IAl i '@RAD-c: 6. A'o@@ I.Y 7. SEX: ;@l 8. @IT: 180 9@ @'@-ADY DATC. @6
i! !I. POR-
14, FF-AS @EG@ DE 15. DATE LAST VISIT: CLASS: 3A
DATE: NO
@l@ A.PPRN@V AUTH.- 21, P,A@'IC/'N'@: 22. VAI-ID@ -.Jpl Y9
23: MTF 3RIC: A@150 USA DTSr'ENSAD 24@ I@,A@3 ORIC; DE D,D
I i,Y
25. @@IT DEST; 070 USA R@I.C t4l@ BADEN GE 26. ICAO DEBT: EDAP
.F r-5F -9
!@.ED SPEC 1; 0,8. ',-IAG 1: 76650 UNSPECIFIED CF.@ST PA't@'
19. M@@p, 2: 3'@,@ DIAG 2:
3'@. @'.7-D SPEC 3@ 3" DIAS
3',A.
7, SPEC DIET: Y!@NONE 34. IV!
02/LPII.@ 36. EijC7i: iN -@7. @i'C I @lr-:: N 38. RESP: N Fl@ILP-Y: N 40. STRYKER: N
41, TNC'J : N42. TRACT: N4' 43. Iric-D: N 44, r,AST/LOn- i4 45. TR@ACH: iN 46. i@.lq: N
71. PT BAG TYPE: NB 72. PT ;;AS TAB 7'. PT BAG WTi
47@ SUP@O INFO: 59" SIG COPPS @T HUA@@@,iUCA A7/1@ T AT@IYI NO MO@,IITOR NO 02 - NO
ATTENDANT
50. ALT Rc@ST/,,IAX H'i N
9
I
@3, @NPAlIc@@4Ti Y 54. SPEC PROS: VA DRUB ALCOHOL WT NONE X 5i. VA CODE:
@6@ A@@,N!N/OVc@R@.@cAS:
m
58, VITAL SIGNS(Tc@@P/PUI@S-t/RESP/BLOOD 0,RESS); 098@O 1 80 / 16 / lig 78
59@ H'oB: 60. HOT: 61@ ABS: I DATE TAKEN:
62. NBC: 63. SI/VSI: 6@'. i@,c@DICATICiNS! NONP-
(b)(6)
6@'. HISTORY: ADMIT]-ED 26 DEC !-OR SHARP PAIN, LEFT SIDE OF CHEST LASTING 7,-5
ASSOCIATED WITH RADIATION OF PAIN TO LEFT ARM. PARAST -- IA, NAUSEA
r H-B
AND FEELING FAINT - HISTORY OF HEART PROBLEMS AS CHILD - PARENTS NOT
.1
A LOW' SURGERY - OUT OF AO@
66. ATT PHYS: AUSTIN 67. PL'#: 434 345 6789 68. i4ARD"/PH#: 089 58@. 895 9555
69@ REPORTED BY; DREYER 70. PH4@ 987 56j6
76. GRADE:
,7, AGE: 76. SEX: 78A. 14Tt 79. RELATIONSHIP TO PATIENT!
80. BAG TYPE: 81. RAG TAG 82. BAG WT:
83. ATTENDANT NAME -z: 64. STATUS: 85. GRAI,'E:
84-. AGE: 87. SEX: 87A. WT: 88. RELATIONSHIP TO PATIENT:
89. BAG TYPE: 90. BAG TAG 91. BA@ WT:
72. TRANS ORIG PHONE EXT@
9,-,. I ANS DE-ST PHONE EXT:
.R
94. ETA GRIG @i-IF(DATE/IIMf-:); 000 1 95@ ETA DEST MTF(DA.Tt-/TPiE): 000
97. OTHER COMMENTS:
il, rjSN @i 0000/361 52. RON LOC;
,7. A.'@IDATP-D BY/REAS FOR HIGHER PRECEDENCE:
96. AIRCRAF71 ITINERARY: /1
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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