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File: 092396_aug96_decls5_0008.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
C6.1".@29 **** PATIENT FILE ****
PERSONAL DATA - PRIVACY ACT C-c '914
13. @,'IODE@ .4
15 -D@N@E
NAME: 16. AUTHORITY #: 07 7AOO5 2. SSAi%!: 3, PRECT - : R
4@ STAT; All 5. GRADE: E'v6 6. AGE; 30Y 7. SEX: F S. @IT: 132 9. READY DAIE: 3'-,7
10, -IF,: li@ POR: 12. SPEC CAT.-
II,. REA.6 REG@ DS 15. DATE 'LAST VISIT@ 16. CLASS: 3A
19. APPT/6',jRG DATE@ NO
ACCEPT PHYS: U'i@iRD 5 U.S.C. 552 (b)(6)
20. APPROV AUTH: 21. CAN,@/l.,@C: '@2. VALID: CWLI Y5
23. MiF ORIG- A5150 USA DISPENSARY DHAHRAN 24. ICAG ORIS: DEDR
E 26. ICAO DEST: EDAF
27. @'ED SPEC '-, SSE 28. DIAS 1: 2396 NEOOLAS'O OF UNSPECIFIED NATURE OF OT ER SPECIFIED BITES
29. PIED SPEC 2., D143 2:
31. riED SPEC 3t --,2@ DIAB
@2A. PROCEDUR-'-@
SPEC DIC@T@ 34@ IV:
9. FOLEY:
C,2UM: N 1 36. gj"ut@ N 37, NG TUBC@- c@' 38. RESP: N'@ i'k' 4fl. FRYKER- N
41. !NCUB: N 42, TRACT: N 4@. ii@ED: N 44. CAST/LOC: cN' 45. 'RACH: C 46. riON: N
71. PT BAB T PC- NIB 72, PT BAG TAG 7'0. PT BAB @IT:
@y 1,
47, Sul,-P INFO: FT EUSilE, VA /123
48. IN,AX @-ik@RTE STOPS: Y / 9 49. ITAX ii. RONSI Y 50. A' i RE@-TPI iAX Hi: N
@z. INPATIENT Y @@4. SPEC PROG: VA DRUG A' CH@UL W.T NONE X 5@.. VA r@TiDE@
@@6. ADM.IiN/DVERSEAS:
@s. VITAL STGI\S(T MP/PULSE/RESP/BLOOD PRc@SS): 09S.6 68 16 120 1 68
59. HC@ 60@ 61@ ABG! 1 DATE TA@El'@
63@ SIIVSI: 64. i','.EDTC.ATIC@162 IigVE
6@@. HISTORY; NOTED IliASS RIGHT THIGH 1 'v.'EEK AGO PATIENT NEEDS SI'ROERY/QRTHO
n!'CLr!l@nUBY - OUT OF AOR
66. ATT PiYg: SiO@'z@Ll- 67@ PH4: 000 000 000n 68. Wfrd#/P@44: 000 OciO 000 0000
69, REPORTED BY: DREYER 70. PH#: 000 C@O@10
74, ATTENDANT NAim-@ #!: 75. STATUS: 76. GRADE:
77. AGE: 78, SEX: 76A. V@T@ 79@ RELATIONSHIP TO PATIENT:
80. BAG TYPE. 81, BAG TAG 82. BAG WT:
83, ATTENDANT NAV.E #2t 64. STATUS@ 85. GRADE;
86. AGE: 87. SEX: 87A. WT! 88. RELATIONSHIP TO DAT'ENT:
69. BAG TYPE: 90. BAG As 91, BAB ti'T:
92. TRANS GRIG PHONE EX':
9@, T AN'S DEST PHONE EXT:
I iR
94. ETA ORIG MTP MA.TE/TI@E): O,)O 9@'. '@iA DEST tITF(DATE/Tli@iE): 000
97. OTHER COMIliENT
. RON LOC:
57. VALIDATED BYIREAS FOR PJCP@-.-R PRE@@EDEN@',@E: f
96. AIRCRAFT ITINERARY:
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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