PERSONAL DATA PRIVACY ACT OF 1974 4 JAN 91

File: 092496_aug96_decls4_0002.txt
Page: 0002
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








                                                                                                                                  01/04/91
                   .6:13*24                                             PATIENT FILE itim
                                                             P@r.\'AL DATA - PRIVACY lr.T 0-- 1974


                                                                 5 U.S.C. 552 (b)(6)
                                                                                                                              13. MODE: A
                                                                 18. AUMC
              ME:                                                           RITY #., 1002AO58 2. SSKN"                        3.  PRE           R
              STAT: All              5. GRADE: E04               6. AGE: 20Y         7. SEX: N             B. Wr:   135       9.  READY DATE:        I
         10.  ISO:                   11. POR-.                                                                                12. SPEC CAT:
         '4.  REAS RES: DS           15. DATE LAST VISIT:                                                                     16. CLASS: 3A
         17.  ACCEPT PHYS:                                                                                                    19. APPT/SURG DATE- NO
         20.  APPROY AUTH.-                                                        21. CAN'C/INC-.                            22. VALID:                 JY,@@  Y3
         23.  MTF CRIS- A5150        USA DIVMRY DIJ@4                                                                         24. ICAO CRIS:     OB.R
         25.  MV DEST: F5070         LIBACMC WIESBADEN GE                                                                     26. ICAO DEST:     EOF
         27.  Fa SPEC I.- SCO        28. DIAS 1: 71681       OTHER JOlt(T DMNGULNT, NEC INV,?@VIKS @ER RESIO.NL
         29.  4ED SPEC 2:            30. DIAS 2-
         31.  r.ED SPEC 3:           32. DIAG 3:
OCEDURE:
         33. SPEC DIET:              .4/                                           34. IV:
         35. 02/LP'i: N              36. SUCT.        N      37. NG TUBE.- N       39.  RESP: N                         39. FULD-.       N      40. STRYKER: N
         41.  INCIJB:                N42. TRAV: N            43. IMB: N            44.  CASTILO'@: N                    45. TPACH-.      N      46. PRGN: N
         71.  PT Bra TYPE-.          la                      72. PT BAG TAB    I-.                                      73. PT MO 6'T-.
         '7.  SUPP I\
                                     FG. HHS @.1, BE                                                           ///173   MED//
              ///85 EVAC///
         49.  MAX EXRTE STOP3: Y / 9                         49. MAX # RDNS:     Y    9                                 '.10. A"T REST/IIAX HT: N
         53.  I@ATIENT: Y            54. SPEC PROS:          VA  DRUG     ALMHZL        WT      NO,\E X                 55. VA CODE:
         Sb.  AD.4IN/CVERSEAS:
         @g.  VITAL SIGNS(TE)9/P@REP/Bi-G3D PRESS): 098.0                        70     18 /    110        70
         59.  FSB.                   60. HCTT                61. ABS-                                 / DATE TA.;al,.
         62.  Wr..-                  63. SI/VSI:             64. ISICATIM:        14'X




         65.  HISTORY: FECLTMU D164-OCATICli          (R)    MIJO - MS          SLRMYIREHAB










         66.  ATT PHYS: @IELD                         67. PH#: 000 000 0000                           68.  WAFtD#/PH#: 000 / 000 000 0000
         69.  REPORTED BY:               NS                                                           70.  PH#: ODO 0000
         74.  ANV@ANT NAIE #I.                                                                        75.  STATUS:                           76. 6RADE-
         77.  AGE.                                    78. SEX:             78A. WT:                   79.  RELATIONSHIP M PATIENT:
      81. BAB TAG                                     82.  BAB WT:
         a3.  ATTENDANT              \'AYZ #2:                                                        84.  STATUS:                           85. G.WE:
         Eb.  AGE:                                    87. SEX:             97A. X                     88.  RELATIONSHIP TO PATIENT:
         89.  BAB TYPE:                               90. BAB TAB                                     91.  BAB 6T:
         92.  TRANS CRIS PHG'IE                              EXT:
         93.  TRP416 DEST            PE@@                    EXT:
         94.  ETA DRIG KTF(DATE[Tltf): 000                                                            95.  ETA DEST MV(DATE/TK): 000
         97.  OTHER DC               :



         5:.  vSN #: 0000/001                                                                         52.  RCN LOC:
         57.  VALIDATED BY/REAS FOR HIGHER PRECEDENCE:
         95.  AIRCRAFT ITINERARY:             I                                           I

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