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File: 092396_aug96_decls5_0014.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
')6:33:29 1 -19/90
**** PATIENT FILE 121,
ViA - PRIVACY ACT OF '914
13. r.10DE: A
18. AUTHORITY #: 0356AO30 2. SSAN: PRECEDENCE: R
4@ STAI@ All 5. GRADE: E05 6. AGE: 29Y 7. SEX: -M S. NT:
160 9. READY DATE: 356
io. ISO: 11. POR: 12, SPEC CATI
'4. REAS REG: DS 15. DATE LAST VISITI 16. CLASS: 3A
17. ACCEPT PHYS: J@NRO 5 U.S.C. 552 (b)(6) '@9. APPT/SURS DATE: NO
20. APPROV AUTH@ 21. CANC/INC: 22. VALID: I PIW'@ Y2
23. MTF GRTG; A5'30 USA DISPENSARY DHAHRA.@L 24. ICAO DRIG: OUEDR
25. MTF DPSTI A5030 FRANKFURT AR!MY REG i@ED 26. ICAD DEST@ EDAF
27@ r!ED SPEC 1: SO@o 28. DIAG 1: 3669 'UNSPECIFIED CATARA.@@j
9. MED SPEC 2: 30@ DIAC 2i
31= NED SPEC 3: 32. DTAG
3@@A. PROCEDURE:
77
I'@ EPP'@ DIET: tN/ 34. TV:
35. 02/LPM: N 36. SliCT: N '@7, NS -iL]BEt N 38, RESP: N 1,9. FO@@EY@ N 40. STRYKER; N@
41. !NCUB: N 42, TRACT: N 43. IIIED: N 44. CAST/I@oC@ N 1 45. TRACD: N 46. iN
71. DT BAB TYPE: NB 72, PT BAG TAB 7-@. PT BAG t4T:
c
47. SU@DP INFO: **,"NTCOMC,',IRO. 14F.ERE IS PT'S DUTY STATIO,@,'-,? (JMRO/CLI)47 CSH REDOR
TP BY 44
,-D
46. MAX ENRTE STOPS: Y I ? 49. @AX # RONS! Y 9 50, ALT Rc,ST/t,'iAX HT: N
53. INPATIENT: Y 54, SPEC PROST VA DRUG AICLIHOL ',4T NONE X 55. VA CODE:
56. ADilI@NIOVERSEASi
5& VITAL SIONS(TEM..-@/PLILSE/RESP/BLOOD PRESS): 097.8 72 16 I'@O 76
59. 14.'uB: 60. HCT: 61. ABG: DATE TAKEN-T
62, WBC: 63. SI/VST: 64. i@FDICATICt4S: NON@E
1
65. @'ISTORYt 29 'i'R WITH DE'UREASINIG VISION TN RISHT EYE WHICH HAS 006c,NED LAST F
E@' 11ONTHS,
66. ATT PHYS@ PIOL MADER 67. P@'#: 000 000 0000 68. WARD4/PH#: 000 Q,'Vo 000 'VOOO
70. Pp@#: 000 0000
,4. ATTENDANT NAtyiE #I; 75. S;@ATUS: 76. GRADE:
77. ACE: 78, SEX: 79A. @l'(: 79. RELATIONSHIP TO PATIENT:
Of)@ BAB TYPE: 81, BAG TAB 82. BAG 1,4T:
63- ATTENDANT NAME P2: 84. STATUS: S5. GRADE:
86. AGE@ 87. SEXI 87A. @jT: 8@ RELATIONSHIP TO PATIENT:
89. BAG TYPE: 90. BAG TAG 9'. GAS WT:
92@ TRANS ORIG PHONE c@XT:
93. TRANS DEST PHONE EXT:
O@10 95. ETA DP-SI MTF(DATcl/TIME): 000
94. ETA ORIG MTF(DATEI'1,4',E);
97. OTHER CO@IM.ENT
.6
51. !ISN #! 0000/356 RON LOC:
HT
57. VALIDATED BY/REAS FOR @GHER FRECr-n.@CN@@E:
96. AL@RCRA.FT 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