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File: 092396_aug96_decls5_0017.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
**** FA.TIE.N'T FILE **** i2/29/70
PERSGi\'A-- -vAiA - PRIVA@@Y ACi OP '974
'3. A
1. NIA,.'4,E: 18. AUT@4'CRITY #: 0356AOO3 2. ESA@NI: 3, PRECEDEN"@@--
4. Sigi: All 5. GRADE: E04 6. AGE: 2?Y 7. SEX@ tl S. W'@ 195 9. READY DATEI 355
!(I. ISO. 11. POR. 12. SPEC CAT:
14: REAS REG: DS 15. @@AiE LASI VISIT@ 5 U.S.C. 552 (b)(6) 16. CLASS: 7A
17@ ACCEP, PHYS: 19. ADPTISURS DATE: [in
20. APPRCV Al@@TH: 21@ ' A,"@@/INC@ 22. VA!-ID: CWH Y7
2 @MTF DRIG: A5150 USA DISPEI\!SARY DPP,@RAi\l 24, I'UAD ORIC: GELIR
I ',!TF DESTI a -6
@5.i F@@07'0 USAFRil'@ WIc@S'DADP-N G' I . ICAD DEST: EDAF
-T TER'S DISFAO@E
01. MEtj' SPEC 1: lit'ii 28. DIAG 'I: 0993 R@
29. P@.ED SPEC 2: 30, DIAS 2:
@i. t@iED SPEC 3@, DIAS 7,t
@,2A. PROCEDURE:
77
@l, SPEC DIET: i%@/ 34. IV; i
35. 02/LPVt@ tm' 36@ Sli@T: li 37@ @Nra TUBE: N 39. RESP: N 39. FOLEY: @N 40, STRYKER: ii
41. ',NCUB: N 41@. TRACTI N 43. !,MED@ N 44. CAS-i/L'uc: iN 11 45. TRA.CH@ N 46. VO@4: N
7'. PT BAB TYPE: KID 72@ PT BAB TAG 7@ PT BAB t@IT:
47. SUPP liNFO.
48@ MAY C,NRTE STnpS; y I 9 49. MAX # RONS; Y 50@ ALT REST/MAX 4T: N 1
INPATIE@,T-. N 54, SPEC PROB! VA DRUG A'LCOk'Ol@ @'4T i%Oi'@E X @,5. VA CODE:
56. A.Dimli@'/DVERSEAS@
@ls. VITAL SIGN'S(TEriP/PU'@SF-/RES'/B'@@uOD P@nESS):
59. @.'GB: 60. HCT; 61. ABO@ DV, E Tiy@EN:
6.'. 6Z. STIVEII 64, MEDICATIONS TCIECTlt4 I TAB 2DAY BID
65. HiSi-O@-Y: WORKDP FOR OEITERS SYNDROYIP. REPIOMVI@ND BUT O@ ACP,.
66. ATT PH.YS: 'WHITFIAN 67. PH#: 999 999 9999 69. ARD#/PH#: 999 999 999 9999
6'i. REPORTER BY@ 6UI.0 70. PHO.: q99 7--,99
74. AT Ei%'@,AiN-' NAIME #1: 75. STATUS: 76. BRAD-a:
@T
79. RELATIONS@'TP TO PATIENT:
80, BAG TYPE: 31. BAB TAB 82. BAG WT;
83. ATTENDANT NAYIE 94. STATUS: 8@@. GRADE:
86. AGE- 87. SEX: 67A. @IT: 88@ RELATIO)x@S@41P TO PAT'4ENT:
89. BAG TYPE: 90. BAB TAG 91. BAG t4T.
97@ TRAINS CRIS PHONE Ext:
93. TRANS DEST PH.DNR EXT@
94. ETA ORIG i@ITF(DATE/TIr@.E): 000 95. ETA DEST @TF(DATE/TIM'C): 000
?7. NHER
@ll, Vista 4@g 9999/355 52@ RO@,@ LOCT
57. VALIDATED BYIREAS FOR F.I&-,IER P.RECED---N'@E: i
96. AIRCRAFT IT TNERARY; 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