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File: 092396_aug96_decls5_0016.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
OLI:@-.4:24 PATIENT FILE @129/90
PERSONAL DATA - PRIVA@@Y ACT OF ";74
?',ODEt A
1. @AV.E- 18. AUTHORITY #- 0356AOO2 2, SSANI: 3. @.RECEDENL-E: R
4. STAT: All 5. GRAN@E: c,04 6. AGE: 24Y 7. SEX@ S. @JT: 185 9. READY DATE- 355
10. '90; 11. POR: 11 'i2. SPEC CA-1@
l@@ REAS RES: DS '5. DATE LAST VISIT; 5 U.S.C. 552 (b)(6) 16. CLASS; -@A
17. ACCEPT PHYST 19. 0,PPT/SURG DATE: NO
I R
,O. AP' DV Aj',!T@4i 21. CA.,,'@'U/INC: 22. VALID: C@'H I Y7
23. MTF ORII- A5150 USA DISPENSARY DHAHRAN 24. !CAD ORIG: G-'-DR
0 i
@5, PITF DES': F5070 USAFRll'@ WIESBADEN GE 26. ICAO DEST: C@DAF
4 OR ir
@7. M-,D SPEC 1: MVII 28. DIAG 1: 7'0, SAO OILIITISI NOT ELSEWHERE CLASSIFIED
29@ ilED SPEC 2: 30. DIAG 2:
31@ !DIED SPEC '@@ .32@ DIAG 3i
'o2A. PROCEDURE:
33. SPEC DIET: N/ 34. IV:
39. FOLEY:
@5, 02/LPi@j; N 36. SLIP@T: N 37. NS TUBE: 38. RESP: N N 40, STRYKER: N'
41. TNCUB: N 42. TRA.C-I.: N 43, IIMED: N 44. P,AST/LDCt N 45. TRACH: N 46. Vin@N: N
71. PT BAS TYPE: NB 72, P- BAG TAG 4: 77, PT BA@ WT-
47. SUPP IN@o:
46. TIAX ENRT STCIPS: Y 1 9 49. )@AX # RONSI Y 1 9 50. P.LT REST/;@AX HT: N
.E
T 54, SPEC ORul@; VA DRUB ALCLrqOl WT N WE X 55. VA '@ODEI
INPATIENT: N'
56. AD@4'il/@uVc@RSEAS:
58. VITAL SIGi%'S@Tc@ilP"P'JLSE/Rc,SP/m-LCOD :RESS)! I I
T
19. HGB. 61). H@'.. 61@ ABS: DATE TAKEN:
6-,,. WB-@: 63. 61/tiSit 64. IEDICATIONS: NONE
65. HISTORY : T NJLIRY 16 rtOkITHS AGO AT FT BRASS. PT WAS IN THE PROCESS 'OF VIFD
BOARD. UNABLE TO Pc-RFORr., DUTIES. 7iECGiliN'iEND OUT OF AC@R
66. ATT PP.YS: LOWER 67, PH*: 999 999 9-i99 68. WARD#/@H#; 999 99? 999 9?99
69. REPORTED BY@ CLI@-DO 70, PH4@: 999 9999
j4. ATTENDANT NAVE 75. STATUS: 76. BRADE:
77@ AGP@ 78. SEX: 78A. WT; 79. REi -ATIONSHIP TC( PATIENT:
30@ BAG TYPE: 8'. BAG TAB 82. BAG t4T:
NT NAYiE #2i 94. ST TL-9: 6'. GRADE:
,A
86. AGE,. 67. SEX: 87A. VT: SB. RELATIONSHIP TO PATIENT:
89. BAG -;YPF-. 90. BAG TAB 91. BAG WT@
92. TRANS GRIG PHONE EXT:
93. TRANS DEST PHONE
94@ EiA ORIS MiF(DATE/TTvE): 000 95, ETA DES] MTF(DA- /TlrE): 000
IE
97. OTHER COVi@iE@14TS;
5'@, MSN #: 9999/355 52. RON 'LO@P:
57. VALIDATED BY/REAS FOR HIGHER PRECEDENCE:
96, AIRCRAFT IT TNFRARY:
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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