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File: 092396_aug96_decls5_0018.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
1) --@5;06 T
v6. PT,. !ENT FILE '@4/29/90
I @
PERSONAL DATA PRIVACY ACT OF 1974
i3. @@iODE: A
1. \IAV.E: 16, AUTHORITY #@ O3j6AO2@, 2. SSAN: PRE'L@DENCE@ R
4. STATI All 5. u@RAD@-@: c@06 6. AGE: 35Y 7. SEX: @'I 8. W': 190 9. READY DATE-. 356
10. ISO, 11. POP,, 12. SPEC CAT.@
16. CLASS: 2D
14, RCAS DS DATE LAST VT SIT: 5 U.S.C. 552 (b)(6)
n
17. A.@"EPT PHYS; JMRO 19. APPT/SURG DATE; @ig
20, A PROV ALT : 21. CAN /INC: 1,2. VALID@ @u@,,H Y2
lp H @Ic
27. riTF DRIS: A5150 USA DISPENSARY DHAHRAN 24. L@IAD ORIG: OEDR
1
25. MTF DEST: AjC4O 2ND GEN @'OSP LAix'DS7'Ll@4L 26. T@ 0 DEST; EDAR
..A
27. SPEC !-. VIVC 28. DIAS It 4,@39 OTHER AND UNSPECIFIED AI%16IKIA PER@TORIS
--19@ MED SPEC 2@ 30. DIAS 2i
31@ Mc,D SPEC 3t 32. DIAS 3:
7,2A. PROCEDURE:
33. SPEI-' DIETZ Y/NOjNE STATED 34. TV:
3-@-. 1-12/LPM: N 36. SUP@T,. N' '@7= @'S TLr6c,@ N 38. R---GP: N 39. coLEY- N 40. STRYKER: N
41. INCUB: N 42. T I -': N 43. I,.'IED: @l 44. CAB'/LO': @4 45. TRACH- N 46. iv.0i@: @4
.R@C;
71. PT BAG TYPE: ND 72. PT BAB TAG 7@@. PT @AG W':
47. S;Jpp TN@ BTQY 113 FA; 24.D., FT. P.OOD, TX REPORT
I o: Sk@L ED BY
47 C@'i
REVALIDA.IED BY JMRD/CLI.
P.T:
48. MAX ENRTE STOPS@ Y 1 9 49. MAX # 'RONS: Y 50. ALT R"STI@,lAX
53. INPATIENT: Y 54@ SPEC PROG: VA DRUG ALCOHOL t4T NONE X 55, VA CODE:
56@ ADMIN/DVERSEAS:
59. VITAL SIGNS(TEMP/,PULS--@/RESP/BLOOD -RESS): 098.0 80 1 iS 128 78
59. HGE: 60@ HOT; 61. ADU': DATE TAKEN:
62= NBC -. 63. ST/VS!: 6., MEDICATIONS: N@'TRG PASTE
65, HISTORY; I EPISODE OF CHEST P.AIN LASTED 5-10 MINUTES. HAD -@KO AND EXERTION 1,@
HIC@. SHOWED FLIPPED T-WAVC TIN V-' - V5. EKG RESOLVED @l/REST. PLACED a,\,' Nl-iROPA
STE, NO R.@TOPY ON FiGNIlTOR. moNI710P NOW D/C; R/O ili. LAST Ch'.@-ST PAINI:19 DEC 90
AT@-EN ANT NEE3g-7D, PATIENT CN 02 PR,'@'.
66. Ali Ph"iS@ GROVER 67. PH.#: 000 00(i CIOAIO 66, il@JARD#/'PH#, 000 0,00 000 000ci
6q. REPORTED BY: DENTON' 70. PH#: 000 (1000
74. ATTENDANT NAME 4.1: 75. STATUS: 76. CRADE:
77. AGE: 78. SEX: 78A. WT: 1-9. RELATIONSHIP T@j PATIENT:
80. BAB TYPE: 81. SAO TAG 82. BAG T;
83. ATTENDANT NAME 42: 84. STATUS: 85, GRA@IE:
86, AGE: 67. SEX-. 67A. WT@- o@g, RELAT'@ulkISHTP Tn PATIE@,'Tt
69. BAB TYPEZ c?v'. BAB TAB *t 91. BAG WT:
92. TRANS CRIG PHONE EXTI
9 .TRANS DEST PHONE EXT:
9q.. ETA DRIS MTF(DATE/-,@Ti@1,E); 000 V5. ETA DEST riTF(DAT-t/TIj@E); C)OO
97. OTHER CDMIIENITST
@, tz
5i. mSN #,; 0000/357 50@. RON 'LOC:
57@ VALIDATED BYIREAS FOR VJ64ER PRECEDENCE:
96. AIRCRAFT 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