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File: 092396_aug96_decls5_0004.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 rT,E **** I'@1/29/90
PERSONAL DATA - PRIVACY A@.- OF @1974
@,or@'-,: A
NAME! 18. AUTHORITY @.: C)357A(106 '@. ESA,4: 3. PRECEDENCE: R
4. STAT@ All 5. GRADE! E02 6@ AGE; 20Y 7. SEX: ii B. t4T-. 160 9. READY DATE: 357
IC,@ TED.@ 11. POR. 12. SPEC @'AT: 1
14. REAS RIci-3.- DS 15. DATE LAST VISIT: 5 U.S.C. 552 (b)(6) 'A-. CLASSI 3A
17. ACCEPT PPYS: 19. APPT/SLIRG DATE:
20. APPROV AUTHT 21. CA@IC/IN'U: 22. VALID: I C'44 Y5
23. MTF CRIB: A5150 USA DISPENSARY DHAHRAN 24. l@ua!l GRIG: GEDR
,5@ ITF DEST: A5030 FRA;'IKFURT ARMY REG @ED 1-6. ICAO DEBT: EDAF
27@ MED SPEC 1: V,,VIU 28. DIAS 11 49390 ASTH@MA, UNSPECIFIED TYPE, STAlUc, ASTHMATICUS NO- MENTIONED
EC 2- 30. DIAS 2-
31@ Mc@D SPEC 3i 32. DIAS 71@
32A. PROCEDURE@
33. S@OER@ N/ 34. !V@ f
35. 02/LPM: N @6. SUC-1@ iN -,,7. NG TUDE@ N' 38. 'RESP: ti' 39. FOLEY: N 40. STRY,@ER: t@
41. INCUP,: 4 42. TRACT: N 43. !VED@ 14 44. CAST/LOC@ N 45. TRACH: N 46@ riGj%': N
71. PT BAG T 11 I l@B 72. PT BA.2 TAB 73. PT RAr@ NT:
Ly. E
47. SUPP INFO: FT BRA.36, NC /144 MP-DII
il2B u@H//
49. IAX EN.@TE STOPS: Y ! 9 49. MAX 4 RONS: Y I I? 50@ ALT RESTIMAX HT: N
INPATIENT: Y @,4z SPEC PROS; VA DRUG ALCOHOL WT NE-NE X 55, VA. CODE:
56. ADIIINICVERS-,As:
58@ ViiAL SIONSiTEii@P/PU;_SE/RESP/BLGu-D PRa'Sg): 09'0.6 / 66 1 12 104 1 70
,9. HGB: 60. HCT: 61. ABS: I DATE TAKEN:
62. NBC: 63. SI/VS7: 64. @'icDICATIG.NS: THEODU.R 3(JO@fro' BID-, VO..NICERIL INHALER
2 PUFFS DID,, INTAL INHALER 11 PUFFS n@ID; HUMABID 12(10,Mo@ TID; KEr7LEX 50oris DID
65@ HISTC,,RYI R@-@CU,-rRENIT ASTHMA SY,@,PTOd.9 DTSPITE INCREASING MEDICATION PRDBLEI".
OUT OF ADR.
.@@CAPABLE OF COMBAT ENVT @IiEi%T.
66. ATT PHYS: SIPPO 67. FH4: 999 990 9?99 68@ @IARD#/r@'4.#i 997 909 999 9999
69. REPORTED BYt EST ABBOTT 7(,. PF@'#@ 999 li999
74. ATTENDANT NAME #I: 75. STATUST 76. GRADE:
77. AGE@ 76. SEX@ 78A. t4T: 79. RELATIONSHIP TO PATIENT:
S%@). BAG TYPE; SI. BAG TAB 82. BAG WT:
87,@ ATTENDANT NAME #2! 64. STA-IUSI 85. GRADE:
86. AGE: 87. SEX: 87A. WT,. 89. RELATIONSHIP TO PATIENT:
89. BAG TYPE: 90. BAG TAB 9i. BAG WIT:
9'.. TRANS @@RIG PHONE EXT:
93, TRANS DEST PHONE EXT:
94. ETA ORIS MTF(D,4TE/TIME): 000 1 95. ETA DEST @A@F(DATcl/TIVE): I)OG'
97, C,-IYIP CD,'IjnNTS,
51@ MSi\l #: 00@@o/,@57 52. RON LOC:
'E@ENCE:
57, VALIDATED BY/REAS FOR HIGHER PREL
ARY; 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