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File: 092396_aug96_decls5_0001.txt
Subject: PATIENT FILE
Box ID: BX000482
Document Number: 4
Folder Title: MEDSTAT - SITREPS DEC 90 4 OF 6
Folder Seq #: 8
Unit: ARCENT
Parent Organzation: CENTCOM
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PATIENT FILE 111/29/0@
D TA
ERKN.NL - PRIVACY ACT OF 1974 (%4 cq6
'B@ AUTHORITY #: tl357A,016 2@ c@SANt pr. CEDENR
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4. STA.T. 11 f@RAu'E. Vf)4 6. AGE: 41Y SP_x@ B. WT: 168 9. READY DATE; @57
,@v. ISO: 11. POR: 1'4. SPEC CV:
14. REAS REC: DS '5@ DATE LAST VISIT% 5 U.S.C. 552 (b)(6) i6. CLASS: 'P@
17. ACCEPT PHYS: 19. AFP';/SURO v'ATE-. NO
20. AP.PROV AUT : I
@W'.4 1 Y2
23. ri,-'F @nR!G@ A5! USA DISPENSARY DHAHRAN 24. ICAO '@RiC.- CEDR
MTF DEST: F5070 USAFPMC @IIESBADE,N GE 26. IC@QD D-,ST@ caA.F
27@ FIED SPEC It MPFC 28, DIAG 1: Zi)83 OTHER ACUTE REA,@lizi--@NS -i-u STRESS
29. MED SPEC I.: 30. DIAS 2:
3'@ riED SPEC 3: 32. DIAS
72A. PRD@'EDURE.@
37. SPEC DT'CTI: iv,'/' 34. IV@
35, 0211@pi@. t4 36. SUCI: @N", o'7. No@ -[UBE: @l. 36. RESPI N 39, Foi-Eyz N' 40, STRYKERT N,
41, l@N'@uBi N 42. TRACTT 43. ll,'ED: N' 44@ CAST/LOC; N 45. TRAC@I: @l 46.
71. PT BAB TYPE: tk'B 72@ PT BAG TAG 73. PT DAB E@T;
A i L
7. S"PP INFOI A 7/101 F' CAMPBE L, k,( 83T EVAC
48, i@AX ENIR@-,E STOPS.@ Y / 9 49. TAX # RDr\'S@ Y 9 50. AL' PEST/KisX @qT: N
53@ INPATIENT: Y 54. SPEC VA DRUG ALCOHOL 'AT NONE X 55@ VA "ODE:
56. AD@'@I@N/GVERSEAS:
58@ VI7 L SIGNS(TEim,,O/PLILSE/RESP/B!-COD PR- S)i 099.0 60 16 112 32
@A @S
H.BT,; 60. HOT; 61, ABG-. DATE TAKEN:
611. 63. SIIIVSI.- 64, MEDI@'ATTDSNS.. 4)Al@ILIM NIS Po
65. HISTORYT NON, S@ICIDIAL CHRONIC TEND. KR@.VACIC BACK PAIN SINCE @IETNAti, NOW
REOCCL',@qlN,G lh' THIS THEATER, ',4AS Oil FLIGHT DUTY IN V'gTN'Ajyi A%'D ,NDW rTO;PLA,Ng
C-' T@SPPICRIA, @siXIETY, DISTURBED SLEEP AND WnRSENIt,G OF LO'v,'FR PAIK@.
X-IRAY AND CT 14iNL. .\JO HISTORY OF T
66. ATT @0,9YSi @ Oi%lr'ELD 67. PL' : 000 000 000' 68. WARD#/P,4#: 000 000 O(,,O 0000
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69. REPORTED BY-. JYIRG 7c). PH#: O@)O 0000
74. ATTENDANT ilAME #I: 75. STATUS: 76. GRADE:
77@ AGE-. 72. SEX: '/SA. WT: 79. RELATIONSHIP 70 PATIENT-
80. BAG TYPP@ 81. BAG T G 11 82. BAG W':
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93. AiTENDAt%i NA'ric, #2: 84. SiATI@-8: 95. SRA@ct
86. AGE: 97. SEX: 97A. P,'I. 88. R;-7LATIC.@NSHIP TO PATIENT:
89@ GAS TYPE: 90. BAG TAG 91. BAG @IT:
c ,
92. TRANS CilG PHONE 'i EXT:
93. T ANS D' ' PHONE 'It
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94@ E@A CRIB iMT;:(DATE/TIM'@): 000 95. EiA DES[ @',T@(nA'E/TINIE)! 00(@'
V7. 07HPR Crj'j!ME,@JTS@
51. MSIN #: 0000/,-@58 52, RON LO@l:
57. VALIDATED BYIREAS FOR P.LCS.ER PRECEDENCE:
9i,. AT
@,@'@URAFT ITINERARY-
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Document 18 f:/Week-32/BX000482/MEDSTAT - SITREPS DEC 90 4 OF 6/patient file:09069614061216
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 # = 16
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