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File: 092396_aug96_decls5_0015.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
*-@** PATIENT FILE **** i '@29/9C,
Ic.Rc-:CINAL DATA - PRIVACY ACT OF 1914
I @M'UDE: A
NAME: 18. AUTHORITY 4: 0356AO28 2. SSA,'i4 71. PRECEDENCE: P,
4@ STATI All 5. GRADE: E07 6. AScl! -s8Y 7. SEX: N B. 14T: 15'4 9. READY DATE: 356
10. 190. II. POR; 12. SPEC CAT.
14,. RP-AS REG; DS l@@. DATE LAST VISIT; 16, CLASS: 3A
17. ACCEPT P'HYS: JFRO 5 U.S.C. 552 (b)(6) 19@ APri/SUDG DATE: NO
2C). APPROV AUTH: 2i. CAN,-,/IiNC: 2'z. VALIDT CWH Y2
@3. MT@ OPIG: A51@@o USA DISPENSARY DHAHRAN 24. ICAD ORIG: GEDR
25. ITF DEST: A50710 FRANKFURT ARMY REG NED 26. ICAO DEST: EDAP
27. tlED SPEC It Mril 28. DIAG 1: 25000 DIABETES VEl@LITiS '@/0 F@ENTICi\- OF COi"'iP"ICP@ION', ADULT ON SET
29. PIED SPEC 2. 30. DIAS 2.@
@AS 3:
51. MED SPEC 3: 32, DT
3z'.A. PROCaDUREi
33. SPEC DIc,i: N/ 34@ IV,
35. 02/LPM: N 36. SUCT: N 37. NO TUBE: N @'s. DESP! N 39. FOLEY: li STRYKER: N
41. !NCUB: N 42. TRACT: N 43, IMED: N 44@ CAST/LOP.: N 45. TRACH; N 46. MON: N'
71. PT BAG TYPE: NB 72. PT BAG TAB 73@ PT BAG tiT:
47, SL;PP INFO. **KCENT,@j)?IjY,,RD. WHCRE 4'6 PT'S DUTY STATION-,, (@7i@RO/CLI@47 CEH, R@RPOR
TED BY 44
46. TAX EI%RTE STOPS: Y 9 49. @iAX # RONS@ Y / 9 50. ALT R'@STI@IAX HI; N
53@ INPATIENT! Y 54, SPEC PPOO@ VA DRUG ALCOHOL W7 NONE X 55. VA CODE-.
-,6. AD!,'iIN@/Ot.;ERSEAS.
58. VITAL SIGi\S(TEMP/PULSE/Rcls,D/BLOOD PR@ S)- 047.2 / K, 1 2C, / 1,72 80
59. HGD: 60. HOT: 61. ABB: I I DATE TAKEN:
62, li)BC: 63. SIIVSI- L4. iviEDICAI"'OuNq-- i@n, E
@i. HISTORY: PATIENT W/ CONiRO1,L@-D DIABETES. DEVELOPED SYrP'oFtATIP, DIABETES 'A/
ABNORMAL PAIN. GLUCOSE 255 TRTS '6f)o AND CHYLOM!CIRON LAYER. PAIN HAS RE'@-0
'@vlc,3. @'iEADCLICSTATi,'S HAS IMPROVED '@/ DIET,
0 0000
61?. REPORTED BY: LT Jgi%'ISKEE 7'0. PH#: Ot)O @100t)
74. ATTcll\,DPiNT NAME #I: 7'@. STATUS: 76@ GRADE:
77. AGE: 78@ SEX: 78A. k: 70. RELATIONSHIP To PATIENT:
60, BAG TYPE: 81. BAG TAG 82. BAG WT:
83. AT FNDAN'T NAME 42: 84. ST TUS- 65. GRADE:
,I @A -
86. AGET 87@ SEX: O@7A. @.IT2 88. RELATIONSHIP TO PATIENT:
89, BAB TYPE: 90, BAG iAp. 91. SAO V@-:
?4'. TR.O.'@'S CRIL PH.C@NIC@ it: EXT:
7Q7. TRANS DEST PHONE #4 EXT@
?4. ET n IG rITF(DATE/TIME); 000 1 95; ETA DEST M@F(DAT'C/TIME)@ 000
iA OR
9-1. OTHER P@G@",ViENJT
51, MSi4 #: 00001356 51@. RON LOC:
S7. VALIDATED BYIREAS FOR H16HER PRECEDENCE:
96. AIRCRAFT TTINC ARY: f f
R
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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