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File: 092396_aug96_decls5_0003.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
**** PATIENT FTLC- **** 12/',9/9@v
PERSONAL DATA - PRIt,A@ly ACT OF 1?7@
13. )'IjUDE: A
18, Al@ITHORIiy #: 0 57AOO9 2. SSAN 3, PREP,EDENICEI P,
4. ST@AT@, All S. GRADE: EC)4 6. AGE: 20Y 7. SEX: M S. WT, 12(i 9. READY DATE: @757
10, ISO: 11. POR; 12. SPEC PAT:
14. DEAS REG: DS '5. DATE LAST VISIT; 16. CLASS: 3A
r p
'7. A'L@c, T PHYOI: 5 U. S. C. 552 (b)(6) 19, APPT/SUR6 n,A)E- ti"ul
C/T
o@ APPROV A'@JIH@ 21. CAN INC; '@2. VALID: 1 Y5
41. tljTF ORI-BG A5!50 LISA DISPENSARY DHAHRAN 24, l,AD ORT@'@
2@@. FijF DESTI A5040 2ND 07tN HOS@D LANDSTU.HL 26. ICAD DPSTI EDAR
27. Y@ZD SPEC 1: FMl 28. DIAS 1: 7890 ABDGNFNAL PA.TNF
29. IMED SPEC O@@ SP. lj'IAB 2: 1-890 ABDDIITNAL PA'.4
MED SPEC 3: 32. DIAG
Pn'DC-FDIJRE;
3-,s, SPEC DIET2 Nl/ IV;
TUBE: N@ 36. REEP-. kf @'9. FOLEYI 40. 'oTRYKEF@: .k@
02/LP,'@l,., ki1 36. SLICT: N' 37. k'L
4'. !N@,UB: N 42, TRACI@ '3. l@P-D: N 44. ',ASt/LO@@i N 45. TRACF,: N 46. MON: N
71. PT BAG TYPE: NB 72. PT BAB TAG 7'@. PT BAB D,'Ti
47. SUPP INFO: F] BRAGG, NO A@IED/I
//@ze CBH//
48. i@,,AX @ct@IR'C@ STOPS: Y / 9 49@ j@iAX # RO.'48.- Y / 9 A'-T P@:S'/MAK qr: @4
5@, TN' 0,TIENT: Y 54, SPEC FROG: VA DRUG AL@@OHi7 k!T NONE X 55. VA CODE@
A.DMli@l/OVEREPAS-@
5@ VIT ' SIGNS(T@civiP/PULSE/RESP/BLOOD PR@-@SS)i 0?7 70 / 20 110 70
@AL
59. Hi-38i 6'@). HCt; 6i@ ABS: I I DATE 'AVEN@
f 4
2. WBC: 63@ S'/ @@l - b4. ilcDICATICiNS@ NONE
6'@. HTSTOC- : LO'4 GRAD@ FEVER AND 'LELIS RESOLVED. PERS'STEN- RLO PAM,' AND IT@IFLAM
@ly I I
ATN@RY PALLA.TS ON COLGt\'OSCOPY. PATIENT HAS LOST 'i5 ',BS. RECO.@l@.END OUT G@ AD,3
ANDORSKY 67. P,4#: 999 999 9999 68. WARD#/O #: 999 999 999 9999
69. REPORTED BY, z56T ABBOIT 70. PP,#@ 999 9999
74. ATTENDANT i\Aikl'c #1@ 75. STATUS; 76. BRADE;
77. AGE; 7e, SEX: 7PA. '-@4Tt 79. RELATIONSHIP TO PATIENT:
80, BAB TYPE: 81. BAr-' iAS 82. BAB i4T;
8'@, ATTENDANT NIPIfiE #2@ 64. STATUS: 85@ CRAD;-:i
B6, 87. SEX., 874, nT., 88. RELATIC;,NSH.IP TO PATIC@NT-
87@ BAG TYPE: 90, BAB TAB 91. BAG t4T;
92. TRANS CRIS PHONE 'r: -LKT:
93. TRAIN-0@ DEST PHONE EXT@.
?4. ETA CRIS MTF(DATE/Tl'!@)i 000 95. ETA DEST tITF(DATE/TlYiE): 000
97. OTHER C@uVI',!,ENITS:
OC,100/357 52. RON LOIC;
Z)7. VALIDATED BYIREAS FOR P@IGHE@ PREC-EDEN
96@ AT@RCRAF-') 11T@NERARY@ I
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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