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File: 092396_aug96_decls5_0009.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
06:-01:46 **** PATIENT FILE **** 1210@9,100
PERSONAL DATA - PRIVACY ACT OF 1974
1'. @,.DDE: A
NAME; 18, AUTHORITY #@ 0357AOO4 '@. BEAN: 3. PRECEDENCE: R
4, STPT: All 5. 6,RADE: E@16 6. AGE: 34Y SEX: ri S. i: 195 9. READY DATE; 357
10@ Isot 11. POR@ 12. SPEC @@AT:
14, REAS REr@ DS 15. DATE LAST VISIT: 16. CLASS- A
17. A'@CEP' Puyg: Ji4.,RO 5 U.S.C. 552 (b)(6) 19. APPT/SURG DATE: NO
20@ A@DP@OV AUTH., 21. P@Ai%!'u/'NC; 22@ VALID: CWH@ Y5
411. @TF ORIG: A5'@@O USA DISPENSARY DHAHRAN 24. !CAO ORI'D: OEDR
25. MTF DEST: A5040 @@ND GEN HOSP '@ANDSTU.4" 26. ICAG DEST: C@DAR
27. Vi@-D SPEC 1: SS@N' 28, DIAG 1: 72:)4 BRACHIAL NEURITIS O@ RADICI,'-LITIS \!Os
29. !MED SPEC 2. DIAG 'L:
31. NED SPEC 7@: 32. DIAG 3:
,12A. PROCEDURE:
3. SPEC DIET@ N/ --,4. IV:
36. SI 1',T: 37. NG TU-0,E@ i% 38. RESP: N9, FOLEY: N 40, STRYKER: 'i@
41. INCIJD: N 4-'. TRACT: N 43@ IVIED: N 44@ CAST/',CC: N 1 4'0@ TRA'HI N 46. N
71. PT BAG TYPclt NE 72, P@ PAS TAG 734 PT BA@ @IT:
47@ SUPP INFO: 56 CAV '-@'IESDA I p
"DEN@ .@@ //28 Cg'@//
48, MAX ENRTE STOPS: Y / 9 49. MAX # RSNIS- Y 9 50. ALT REST/MAX HT: i%'
53. INPAT TEN-; Y 54, SPP PROC@ VA DRUG ALCOHOL WT NONE X 55. VA C@@,Dc,:
I-C
,6. ADt4j-@'.N/CVERSEAS:
q . VITAL SIGNS(TErr/PU"SEIRESPIBLOOD PRESS): 099.0 84 16 138 84
@8 1
59. HGB: 60. HCT: 61, I DATE TAKEN-.
62@ NBC: 63. SI/VSi; 64. 14EDICATIONS: NAP.'@4,DSIN 5OAr-,G PO BID, TYLENOL #3 ul
4H PR@..@ PAIN'
o5. HISTORY: R1641 ARM PAIN AND .14'zA@",@Nc@SS FOR 5 MONTHS RcP,C,'i@END NEUROSURGERY
EVALUATION - EVAC T GE.
66. ATT P@4Y@ BROPHY 67. P@4#@ @@o 000 0000 68. AIARD#/PH#: 000 / 000 000 0000
69@ REPORTED RY@ DREYER 70. PP@#: 000 0000
74. ATTENDANT \AM.E #I; 75. STATUS: 76- GRADE:
78. SEX: 78A, @,'@T: 70, RELATIONSHIP TO PATIENT;
80. BAB TYPE: 91. BAG TAG @i 82@ PAS VJT:
83, AT P DA%'T NAME #2: 84, STATUS: 6'. GRAD-:
.T-N
86. AGE: 37, SEX: 87A. WT: 88. RELATIONSHIP TO PATIENT:
89c BAG TYPE: 90. BAG TAG 91. BAG WT@
9'@'. TRANS ORIE PHONE -tXT:
93. TRANS DEBT PHONE EX'i
94. ETA ORIS MTF(DA7iE/TIME): 000 95. ETA DEST MTF(DATE/T!M.E): 000
97, OTHER PIOV.MENT@
51. MSN #; 0000/357 52. RON LO@@:
57. VALIDATED BY/REAS FOO HIGHER PRECEDENCE:
96, AIRCRAFT ITIN@RARY@ I I 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