Document Page: First | Prev | Next | All | Image | This Release | Search
File: 092396_aug96_decls5_0005.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 FILE **** i-11/@,9i9c)
PE.RKuiN'A'- DA-,,A - PRIVACY ACT OF 1974
l'o. !MDE: A
1, NA..ME@ 18. AUTHORITY #: 0357AOIO 2. SSAT%: 3. PRE@LEDENC@a@ R
4. STAT: All 5@ GRADE: E03 6. AGE: 20Y 7. SEXI M WT: 190 9. READY DATE: 357
!So; 11@ PDR. 12, SPEC CAT: I
@4. REAS REG: DS 15. DATE LAST VISIT@ 16. CLASS: 3A.
17, ACCEPT PHYS- 5 U.S.C. 552 (b)(6) Ic, AFPTIGURG DATc.z NO
2@,',. APE'fiOV AUTH: 21. 22. VALID@ r@114H Y5
23@ MTr' CRIS: A@@150 USA DIE'T-:NP.ARY DHAHRAN 24@ ICAG CRIB: OEDR
25. NTF DEST: AJO40 2ND OC@IN HOSP LAiN@IsTijHL 26. IIIAD DEST: EDAR
27. VED SPEC 1: SOOH 28, DIAS i@ 8832 OPEN' W'@UND OF FINGERS, W-ITF, TENDON INVOLVEMENT
29. YicD SO@@c 2z 30. DIAS 2.,
V@ED SPEC 3@@ 7
2. DTAG 3:
,@2A. PR'UIEDUREI
EC 1,T
D'c@: 34, IV@
35, 02/LPri- N 36. SI !CT ti%' 37. N'u TUBE: N, 3& RESP: N 39. FOLEYT t@ 40. STRYV.ER:
41. TNCUB: N 42. TRACT: 43. L@NED: N 44= CAST/LOC: @4 45. T'nAr-'H: N 46. VON:
7'. P! BAG TYPEI NIB 72. PT BAG TAG 0. 13. PT BAB
47. SUPP INFO. @--T BRASS, i'@@IC //44 M.EDII
//-,R CSF@//
48. MAX ENRTE STOPST Y 49. MAX # RO@NS: Y / 9 5,'-'. ALT @'3ESTIMAX H'! N
53. INPATIENT: Y 54. SPEC PROP: VA DRU' P@Lr HOL WT NINE X @@5. VA CODE:
@o
56. ADiMIN/OVERSEAS:
58@ VITAL SIG"S'TEMP/PULSE/RESP/BLCIFJD PRESS): 098@O 54 / 8 120 11 80
59. HSB: 60. HCTZ 61. ABB: DATE TAKEN@
6-/. NBC: 63. STIVSI: 64. MEDICATIONS: kE@LE,@ @Icif)@NG DID
65, HISTORY: LACERATION' Or' LEFT INDEX AND MIDDLE FINGER. FLEXOID TEND@.-INS AND MI
I
DDI-E F'N'@oc@R DIGITAL NERVE. NEEDS HAND SLIRG-'-@Dy AND HAND THERAPY. RECOMiEru 0
I IT OF ADD
66. ATT P@'IYS; HOPKINSCI%' 67. PH@,i 999 999 9999 68. @,IARD#/PH#: 999 999 999 9999
70. PH#: 999 9999
74, ATT -NDANT NAilE #I. 7@. STAIUS: 76@ GRADE:
.r 1
77@ ABE: 76. SEX: 78A. @.T: 79. RELATIONSHIP TO PATIENT-.
80. BAB TYP--@ 81. BAB TAG 82. BAG 'AT:
83. ATTENDANT NAME #2: 84. STATUS: 85. GRADE:
86. AGE! 87, SEX: 87A@ WT: 83, RELATIONSHIP TO PATIENT:
89. BAB TYPE: 90. BAB TAB 91, BAB k'T:
92. TRANS ORIG PHONE #i @@XT:
cFN. TRANS DEST PHONE #: EXT@
94. 'ETA ORTO MT (DATE/TIME): 000 95. ETA DEST IIT (DATE/TIM.-): 000 f
IF F
97. OTHER COMMENTS:
51. @!SiN @; 0000/357 51@. RON LO,-:
@@7. VALIDATED SY/PEAS FOR HIGHER PRECEDENCE!
96. AIRCRAFT ITINERARY: I f I
Document Page: First | Prev | Next | All | Image | This Release | Search
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