PERSONAL DATA PRIVACY ACT OF 1974 4 JAN 91

File: 092496_aug96_decls4_0001.txt
Page: 0001
Total Pages: 31

Subject: PERSONAL DATA PRIVACY ACT OF 1974  4 JAN 91                     

Unit: ARCENT      

Parent Organization: CENTCOM     

Box ID: BX000460

Folder Title: MEDSTAT- SITREPS - JANUARY - 1                                                                  

Document Number:         10

Folder SEQ  #:          2








                   :6:12-04                                         "H PATOT FILE "H                                                 01/04/91
                                                           PEILWI@ CATA - PRIVACY ACT OF 1974

                                                                        5 U.S.C. 552 (b)(6)
                                                                                                                                  13. F.ODE: A
                                                                  18. AUMO@RITY #: 1002AO57 2. SEM:                               3. PRECEDENCE: R
               4. STAT:  All            5. GRADE: E04             6. AGE: 21Y            7. SEX. M             S. WT:  170        9. READY DATE,        I
               10. ISO:                 11. POR,                                                                                  12. SPEC CAT,.
               14. REAS RES: DS         15. DATE LAST VISIT:                                                                      16. CM: 3A
               17. A=    PHYS:                                                                                                    19. APPT/SL.% DATE: NO
               20. I%DPRGV AUTH:                                                         21. CA.%C/INC:                           22. VALID:                UTM     Y3
               23. KTF CRIS: A5150      USA DISPENSARY DFAF.RKN                                                                   24. ICAS CRIS:    CEDR
               25. MTF D@-ST, F5070     LISAFRK@@ 'IESBADLN GE                                                                    26. ICAO DEST:    EDAF
               27. ra SPEC 1: SOD       29. DIAT) 1: 71947 PAIN IN JOIN7 INVOI@VIN@A AMU AND FOOT
               2?. @,ED SPEC 2:         30. DIAG 2:
               3i. @ED SPEC 3:          32. DIAG 3:
               32A. PRO'@BLtK:
               33. SPEC DIET:           N/                                               34. IV:
 N            36. S@'CT:  N         37. N-o TLW-: N            38. RESP-. N                      39. FOM          N      40. STRYKB: N
               4'. ILCLIB:              N42. TRACTs N         43. M: N                   44. CAST/LCC: N                   45. TRACH:       N      46. r.DN: N
               71. PT BAG TYPE: ta                            72. PT BAG TAS                                               73. PT BAG WT:
               47. S@FP IN.@0. A CO     416 IN'F, GE                                                              ///173   10//
               1 I//85 EVACI//
               48. OAX EWTE STCPS: Y        9                 49. Y.AX # RO,%S:    Y     / 9                               50. A'-T REST/MAX NT: N
               !-). INPATIENT: Y        54. SPEC PROS:     VA     DRUS       ALMKI@       WT      NCILC X                  55. VA COD---:
               56. AD.MINIC             :
               52. VITAL SIG.NS(TEP/PLPLSE/RESP/BLGOD PRESS): 098.6 /               70   /20       98          60
               59. F.'oB:               60. H.T:              61. AB3#          I                              DATE TAKEN:
               52. WB@':                63. SI/VSI:           64. MEDICATICNS. ti3?r--




               6@. HTSTMY: @UNIC FOOT PAIN         - FEGUYLG W/ CALCUS - NO CAST -










               66. ArT PHYS: ?IARLC'G             67. PH#: 000 000 0000                                 68.    VA.RD#/PH#: 000 / 00 000 0000
               69. REPC.RTED BY:        ANS                                                             70.    Pd#i 000 0000
               74. ATTENDANT WE #I:                                                                     75.    STATUS:                          76. B.@.
               77. ASE:                           78. SEX:                   78A. WT:                   79.    RELATIONSHIP M PATIENT:
               60. BAG TYPE:                      21. BAG TAG                                           82.    BAG WT:
    NArz 12:                                                        84.    STATUS:                          85. GRADE:
               86. AGE:                           87. SEX:                   87A. WT:                   88.    RRATIC%'SHIP M PATIENT:
               69. BAG TYPE:                      90. BAS TAG                                           91.    BAG KT:
               92. TRW CRIS             Pli9N---           EXTI
               9,. TRANS DEST           PIC%E 9:           EXT:
               94. ETA IIRIG M7(DATE/Tlrc): 000                                                         95.    ETA DEST M7F(DATE/TIME): 000
               57. B-ih'ER MMTS:



               51. M.S.N #: 0000/001                                                                    52.    RCV LO::
               57. t'AIIDATED BY/REAS FOR HIG@ PRECEDENCE:
               06. AIRCRAFT ITINERARY:

Document 31 f:/Week-31/BX000460/MEDSTAT- SITREPS - JANUARY - 1/personal data privacy act of 1974 4 jan 91:09209615580712
Control Fields 17
File Room = aug96_declassified
File Cabinet = Week-31
Box ID = BX000460
Unit = ARCENT
Parent Organization = CENTCOM
Folder Title = MEDSTAT- SITREPS - JANUARY - 1
Folder Seq # = 2
Subject = PERSONAL DATA PRIVACY ACT OF 1974 4 JAN 91
Document Seq # = 12
Document Date =
Scan Date =
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 = 20-SEP-1996