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File: 092396_aug96_decls5_0006.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
E'ATIE@,!T FT '@L/29'9(,
I I @'-E I
PERSONAL DATA - FRIVACY ACT O@ '974
13. MOD@@ A.
18, AUTHORITY 'v: Cl@57AOO6 2. SEATN' 3@ PRECEDENCE: R
4@ STA-F; All 5. GRADE: E@113 'O. AS@i 23Y 7@ SEX; F S. k,T: i4O 9@ READY DATE; ',57
10. ISO,, II. PDR., 12. EC CAT. i
14. REAS REGI DS DATE LAST VISTT: 5 U.S.C. 552 (b)(6) IL, CLASS: 3A
17. A.;-'CEPT PP@YS: JMRO 19. APPT/StiRG DATE; NO
20.APPROV AUTH- 21, 22, VAL TDi CIAH il y@@
z3@ INTF BRIG: A5!50 USA DISPENSARY DHAHRAN 24. ICAD ORI@.: CEDR
25. iitf DESTA A@1030 FRANKFURT ARilY REG iviED 26. ICAD DEST: EDAF
27. riED SPEC I.; riim 'L., DIAS !I 49390 ASTHriA, UNSPECIFIED TYPE, STAIUS ASTPI,'IATICUS NOI MENTIO,@4ED
Z'9. @IED SPEC @l, -JO. DIAS 2j
:@l. @miED SPEC 3@ 32. DIAS 71:
32A. PROCEDURE:
33. SPEC DT@ : iN/ 'i4. IV;
,-T
35@ 02/LPM@: N' 36, SUCTZ N ,7. '@'L TUBE; N 38. RESP: N 39, FOLEY@ 40, SIRYKER: N
4i. INCUB,. N42. TRACT: N -1. .TM.' . CA
,3 @ ED Nl 44. ,St/LO'u: 45. "RAP@H: i\l 46. VON: @4
71. PT BAG TYPE: NB 72. PT BAB TAB 73. PT BAG @i'T:
47, 81,1@OP INFO. STUCARI, GE 114'3 CE@ll
48. ilAX ENRTE STOPS; Y / 9 49. VAX # RN@NS: Y / 9 @,o@ ALT R@'ST/@,AX HT;
S'o@ INPATIENT: Y 'i4, SPEC PROG: VA DRUG ALCOHOL '4T NONE X @i. VA CODE:
56, ADt!IN/n ERSFAS:
@v
39. VITAL SiGNS'TEMP/@D"!SE/RESP/BLOOD PRESS): 098.4 64 / 18 / 100 80
59. HGB: 60, HCT: 61, ABS: DATE TA ENt
61,@ WBPI: 63@ El/VST: 64. mEDICAT'Gl@'s, PPGVR@,NTIL 2 PUFFS OID, THEO
@)OR 300t.iG BID
6@@@ @HTST'@'RY: HISTORY OF ASTHV.A - PATIC T HAS HAD MULTIPLE ATTACKS WI' Ttl
WE @ IU DEP' YriENT - PATIENT UNAS' TO ' LERATE Cn BAT ENV'RO@ic'NT.
i-T @'N@ la I LE 10 @m i
66@ ATT PHYS: SIPPUNE 67. PH#i 000 OAIO O'VOO 66@ 14ARD#IPHk: 000 000 000 0000
69. REPORTED BYi D.RRER 70. PH4: 000 0000
74. ATTENDANT NAiMc@ #I! 75. S'!ATI-iS@ 76. GRADE:
77. AGE: 78. SEX@ 76A@ WTI 79. RELATIONSHIP TO PATIENT:
80. BAG TYPE; 81. BAB TAG 92. BAG WT:
83. ATTENDANT NIANP- #2: 64. STATUS: 85. ERADE@
86. AGE@ 87. SEXT 87A. WTI 89. RELATIONSHIP TO PATIENT:
89. BAG TYPE: 90. BAB TAB 91. BAG WTI
92. TRANS ORIC PHONE Ex,!
93. TRANS DESI PHONE EXT:
94, ETA CRIS @'ITF(DAT--@/Ti@'iE): OC@O 95. ETA DES[ MTF(DATEIITVcl): @1,00
97. OTHER COririENTS:
51. rise #z 0000/357 @,2. RON LOC:
57. VALIDATED BY/REAS FOR FISHER PRECEDENCE: 11
96. AIRCRAFT I@T Nc ARY! I f
-R
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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