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File: 092396_aug96_decls5_0010.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: 2:02 @ATTENT FILE 12129190
;A I
PERSONAL DATA - P@RIVA@@y ACT @UF 1974
13. MODF: A
1. NAME. 16. AUTHORITY #: 0357AOOL S@I.AN: PRECEDENCE: R
4. STA.T; All 5. GRADE: cm 6. AGE: 30Y 7. SEX: S. ',)T; 208 9. READY DATE: 357
10. ISO@ 11. PORI '@2. SPEC CAT: 1
14. REAS REG@ DS l@@. DATE LAST VISIT: 16. CLASS: 3A
17@ AL"@EPT PHYS: JFIRO 5 U.S.C. 552 (b)(6) 19. AP-T/SUR6 DATE: NO
@o. APPROV AU,H: 21. CANO/lel,'C: 2@L. VALID-. @-WH Y5
23. MTF ORIG: A5!50 USA DISPENSARY DHAHRAN 24. ICAD DRIG! OE@R
25. riTF DEST: F5070 USAFRVC WIESBADE.@L GE 26. ICAO DEST@ EDAF
27. MED SPEC 1: SOD 28, D',AG 1: 71782 OLD DISRUPTION OF MEDIAL COLLATERAL LIEPTIENT
29. mED SPEC 2: 30. DIAS 2:
@lt Vc-D SPEC 3: 32. DIAG 3@
@2A. PROCEDURE:
3@. SPEC DIET: 'K4. IV@
7@. G2/1@pii: N' 36. SU'LT: t%l 37. NG TUBE: N' 38. RE@,D@ N 39. FCLEY: N 40. SI-RYKER: N
47o. IMC,D: N 44. @,AST/LC-L: N 45. TRPCHI 46. 'IOiN: @l
71. PT DAG TYPE: NB 72. PI BAG -IAG 73. PT BAB
47. SUPP INFO: FT BRAGG, NO //7,OiT@H @ED BN//
48. MAX ENIRTE STOPS- Y 1 9 49. MAX # R'uN'O,; Y 9 @@o. ALT RES-,@/MAX HT: N I
@3. INPATIENT: Y 54. SPEC PR@,@; VA MG ALCOHOL WT NONE X 55. VA CODEZ
A
@6. ADill;N/OVERS.@ S;
.3. VIT L S'GNS(TEMP/PIJLSE/RESPIBLO@PD PRESS): 098.4 / 76 130 / 84
.A .4
59. HBB: 60. HOT: 61. ABS@ I I I DATE TAVE\I;
62. VJBC: 63. @-!/VSI: 64, MEDICATIONS: NONE
65, HISTORY: PATIENT HAD SURGERY JUN 90- REINJ"@R D JUL 90 - PATIENT HAS
PERSISTENT LOCKING AND 5 ELLING
66. ATT PHYS: LG,,'ijERY 67. DH#t OCIO 000 000,@ 68. WARD#/P,'!#. O@10 000 000 0000
69. REPORTED BY: DREYER 7?,,'. PF@4: 000 0000
74. ATTENDANT NAMC 41: 75. STATUS: 76. GRADE:
77. AGE- 78@ SEX: 76A. 147: 79. RELATIONSHIP TO PATIENT:
80. BAG TYPE: 61. BA TAB 82. PAS WT:
ST., ATTENDA.\!T NAME g@: 84@ STAT S: 85. GRADE:
lu
87A. WT@ 88. RELATICNS',DIP TO PATIENT:
89. PAS TYPE: 90, BAG TA@' 91. BA@S WT:
92. TRANS ORIG PHONE FX7!
93, TRANS DESI PHON-P EXT:
94. ETA CRIB NTF(DATc/TIMP-)@ 000 95. ET DF79T ri@'(DAT /Tli"iE): 000
@A [E
97. OTHER
@l, MSli @': 61000/3@@7 52. RON LO@@;
57. VALIDATED BY/REA.9 FOR HIGH.'CR PRECc@DEtN'@ICI:
96. AIRCRAFT ITTciERARY@
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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