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File: 092396_aug96_decls5_0007.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
PILE 12/29f9O
BONA' DATA. - PRIVACY ACT OF 1974
L
17N. @ODE: A
18. AUTHORITY #: 0357A.007 BSA%: 3. PRECEDENCE: R
8. WTi 145 7. READY DAIE! 357
STAT: A'@ @05 6. ACE: 44Y 7. O@P-X: .,I
10. !SD, II. PFIR. 12. SPEC CAT,
A
14. REAS RED: DS 15. DATE LAST VISIT: 5 U.S.C. 552 (b)(6) 16. CLASS: 3A.
'7, ACCEPT PHYS: JI,4,RO 19. APPTI'SURG DATE: NO
20, APPROV AUTH: 21. '@AN,P,,"..NC: 22. VALID: R@IAH Y5
23. i@TF ERTG@ A51@10 USA DISPENSARY DHAHRAN 24. 'CAD ORIG: OEDR
25@ TITF DESTT A@A30 FRANKFURT ARMY REG ,DIED 26. ICA@O DEST: EDAF
,@i',PE -PIED
.7. i@l@:D SPF@ 1: SSE 28. @T CT
29. TIED SPEC 2. SSU DI,40 2: _C,501f) T,14GUINAL HERNIA @INT' ATERA' OR L;'N'SPECIFIED
31, @'iED SPEC 3- 32. D'AG 3:
,K2A. PROCEDURE:
@3. SPEC Di@cT: N/ 34. lVt
35. 02/LPM: N '06. SliCT @ N 37. T'JBET iN 36. RESP: N' 37. @cOLEYi [4 40. STRYKER: iN'
41. INCUE: N 4'L. TRACT@ 43, N 44. P@A'QT/LOC: i'l 45. i-RACH.: i'4 46. @",CN: N
71. PT BAB TYPE: ik!8 72@ PT BAB TAG 71-. PT @,T-
47@ SLIPP !,NFO.- 62 M@D BP FT LEI,41S,
48. MAX ENqT--@ STOPS@ Y / 9 @17. MAX # RO@Nic@: Y 9 50. Al-T @nEST/FiAX @HT:
57,. TN@ T-- : Y @@4. SF@-C PRO'U: VA DRUG ALCOHOL 1,4T N@NE X 55. VA CODE:
@ A itNT
56. ADi'll@,'IOVERSEASi
@8. VITAL SIO@%'@ TEVjP/PULSc@/RESPIBL'UOD PRc S): 098.' 72 16 / 102 64
59@ p@3B: 6'). '@4@@@T@ 61. ADS: DATE TP.KEtN';
62= t@JBCi 63. SI/VSlt 64. PiEDICATIO@iS@ NONE
65. HISTORY: SYMPTOMS 0-- UR INARY OBSTRUI'7i!CN AND RI@- T INSU'.NAL HERNIA.
I -H@
PATIENT NEEDS TLIRP - EIVAC TC@ GE
000 000 0000, 68. '@'AiD#/PH4@ 000 000 000 0000
69, REPORTED BY-. DREYER 70. PF@#- 000 O(YOO
7
@4. ATTENDANT NAME #I: 75. STATUS: 76. GRADE:
77@ AGE: 78, @@Y,: 7BAw Wi: 79, RELATIONSHIP TO PATIENT:
80. BAG TYPE: 81. BAG TAG 82. BAG WT:
671. ATTENDANT NAME #2: 84. STATUS: 85. GRADE:
86. AGE: 87. Sc@Xi 87A. 'AT: 88, REL4T lo@4SUT P TO PATIENT:
89. BAB TYPE: 90. BAB TAG 91@ BAB @,T-,
914. T NE ORIG PHONE
,RA
9@ TRANS DEST PHONE EXT:
94, ETA ORIS iMTF(DATE/TIM@-)@ 000 95. ETA DEST i@TF(DATE/TI@@IE); 000
,7. OTHER COMMENTS:
51. rSN #; 0000/357 52. RON LOC:
@@7. VALIDATED BY/REAS FOR -i!CP.ER PPE@@EDEN@r-E- 1
96. AIRCRAFT ITITNERARY; 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