PERSONAL DATA PRIVACY ACT OF 1974 4 JAN 91

File: 092496_aug96_decls4_0003.txt
Page: 0003
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








                   .6:13:41                                              PAT!ERT FILE w@w@                                          01/04/91
                                                                  PBM.'4'L DATA - PRIVACY ACT OF 1974

                                                                        5 U.S.C. 552 (b)(6)
                                                                                                                               13. F.GDEI A
                                                                  18. ALffHORITY I.- 1002AD60 2. ssi%4:                        3. PRECUENTE. R
               4. STAT: All             5. GRADE: E04             6. AGE: 20Y             7. SEX: N         S. WT:    190      9. READY DATE-.        I
          IC.  ISO.
                                        11. POR.                                                                               12. SPEC CAT:
          14.  REAS REG: DS             15. DATE LAST VISIT:                                                                   16. @: 3A
          17.  ACCEPT PHYS:                                                                                                    19. APPT/SMS DATET N3
          20.  APPROV ALR:                                                           21. CA\C/Itr,:                            22. VALID:                 imc     Y3
          23.  KW CRIS: A5150           LISA Di      Y DKTLLMI                                                                 24. ICAD DRIG:     GER
          25.  MV DEST., P.070          LISAFPjvC WMP-ADc-4       GE                                                           26. ICAD DEST:     EDP4r
          27.  KED SPEC 1: M            28. DIAS 1: 81400         CLOSED FRAME OF   CWA'@ BC!,E,     LNSPECIFIED
          29.  @Z) cKC 2i               30. DIAS 2:
          @l.  Mt-D SPEC 3:             32. DIAS 3:
          32A. PRGCBI.'RE.-
          33. SPEC DIET:                N/                                           34.  IV.
LPM- N                 36. &O-    N              37. NG nut N       38.  RESP: N                        39. FC-'.U:       N     40. STRYKER: .4
          4'.. INU:         N           42. TRACT* N              43. IKB: N         44.  CW/Lg@@: N                     45. TRADis        N     46. MON: N
          71.  PT BAG TYPE: NB                                    72. PT BAG TAG                                         73. PT RAG WT:
          47.  SUPP IK-0: C CO          701 FA, FT RM,            KS                                            ///173   MD//
          / ///85 EVAC///
          48.  TAX ENRTE STOPS: Y           9                     49. MAX I ROM:  Y       9                              50. Al-T REST/mAx HT: N
          53.  Ik?ATIEN'T: Y            54. SPEC PRCB-            VA DRUB  ALCCHOL        WT     NM x                    55. VA CODE.
          !6.  ADMIN/gVMEAS:
          58.  VITAL SIM(TEm?/PLP-WRESP/BLOOD PRESS): 098.0                       70      18 /   110        70
          59.  HGB:                     60. HCT:                  61. ABS:                                  DATE TAKEN:
          62.  kBC:                     63. SIIVS13               64. MEDICATIONS: NCKE




          65.  HISTORY: PT FX (L) NAVICU-AR - tMS L(N'S (LRM SPICA CAST                   FOR 6-8 6KS. PT
          CANNOT F6W.710H IN AOR - PT FELL OFF TR.CK. (CASM LL 12/27).








          66.  ATT PHYS- MAJ G&NARD                67. PHI: 000 000 0000                                    68. WPLRU/PHO. 000 / 000 000 ODOO
          @9.  REPORTED BY: @@ANS                                                                           70. PH#: 000 0000
          74.  ATTENDANT ME #I:                                                                             75. STATUS:                       76. GRADE:
          77.  ABE:                                78. SEX:                 78A. WT:                        79. RT-LATIO.ZKP M PATIENT:
                     82. BAG kT:
          83.  ATTENDANT    %If- #2:                                                                        84. STATUS:                       85. G.RADE-
          B6.  AGE:                                97. SEX:                 87A. WT:                        88. RELATICNNIP TO PATIENT-
          89.  BAG TYPE:                           90. BAB TAB                                              91. BAS UT:
          92.  TPAIS CRIS PHONE                                   EXT:
          93.  TRA.'S DEST PF.M                                   EXT-
          94.  ETA DRIS ?U(DATEfTItLc). 000                                                                 95. EiA DEST 147F(DATEITIME): 000
          97.  OTHER M@TS:



          5'.. MS.1 #: 0000/001                                                                             52. RC4 LOC:
          57.  VWIDATED BY/REAS FOR HIM PFTECEDENCE-
          96.  AIRCRAFT ITINMQY:

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