PERSONAL DATA PRIVACY ACT OF 1974 4 JAN 91

File: 092496_aug96_decls4_0006.txt
Page: 0006
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








                16:14i25                                 *"4 PATIENT FILE "H                                    01/04/91
                                                       PERSONAL DATA - PRIVACY ACT OF 1974
                                                           5 U.S.C. 552 (b)(6)
                                                                                                            13. Mgi'E- A
             I. NArti                                  18. AUTUI ITY #: 1002AO54 2. SSN4:                   3. PRECEDENCE: R
             4. STAT: All       5. 6,RADE: E07         6. ASE: 30Y         7. SEX: M        S. WT:  175     9. READY DATE:      I
             'O. ISO:
                                11. PCR:                                                                    12. SPEC CAT:
             .4. REAS RES: DS   15. DATE LAST VISIT:                                                        16. CLAM: 3A
             17. ACCEPT PHYS:                                                                               19. APP7/&25 DATE: NO
             20. A.2PROY AUTH.-                                         21. CANC/INC:                       22. VALID:              imc   Y3
             23. MTF ORIS: A5150 LroA DISPDSA.RY VM4                                                        24. ICAO DRIS.   OEDR
             2@'. ',iTF DEST: A5030 FRICOW ARKY RES P.B                                                     26. ICA3 DEST:   EDAC
             27. MED SPEC I- SOO 28. DIAB 1: 7173      OTHER M UNSPECIFIED DRANSEKENT OF KOIAL MAISCUS
             29. MED SPEC 2:    30. DIAS 2:
             3:. 10 SPEC 3-     32. DIAS 3.
             32A. PRCCEDURE.
             33. SPEC DIET:     NI                                      34. IV.,
             35. 02/LPM: N      36. FOCT:  N           37. NS TUBE., N  38. RESP: N                    39. FIYM;      N     40. STRYKER: N
             41. 103:           N42. TRACT: N          43. IMED: N       44. CAST/LX: N                43. TRACii:    N     46. PON: N
          71. PT BAB TYPE-. NS                      72. PT BAB TAG 8:                               73. PT BAB 6'T:
             47. SLPP Itt7g: 327 CHEMICAL, BAY CITY    TX                                      ///173  MEDI/
             / ///85 EVAC///
             49. MAX MRTE STEPS: Y / 9                 49. ?IAX # RUNS:Y   9                           50. ALT REST/r.AX HT.- N
             53. INPATIENT. Y   54. SOEC PfWa:         VA DRLS  iV-M'-      MT    NONE X               55. VA CODE:
             56. ACIIN/UY       :
             59. VITAL SIGNS(TElf/PLP@RESP/BLC3D PRESS)I 098.8       80     20    114 /     68
             59. P.GB:          60. HCT:               61. AEG:                             I DATE TAKEN:
             62. Wlr..          63. SIMI:              64. FOICATIC,@: NO.'IE




             65. HISTCRY: PAI*VL SWMM L KNE - ikNTBICR HORN TEAR BY EXAli         INJUM
             '7 N'
             , ,V 90 - RIJ'NING - NO CAST.








             66. ATr PHYS- GREENFIELD      67. PH#: 000 000 0000                            68. WARD#/PH#: 000 / 000 000 0000
             69.                BY: @ANS                                                    70. P]4#- 000 0000
             74.A@4T NAYE #I:                                                               75. STATUS:                  76. 6RADE:
             77. AGE:                      78. SEX:             78A. WT:                    79. RELATIONSHIP TO PATIENT:
             90. BAG TYPE:                 81. BAB TAB 1:                                   82. BAB WT:
             83. ATTENDANT      NA.IE #2:                                                   84. STATUS@.                 85. GM:
             86. AGE.                      87. SEX.-            97A. WT.                    88. R-3fiTIOWUP TO PATIENT:
             89. BAB TYPE:                 90. Wo TAB 0:                                    91. Rra NT:
             912. TRIL\'S C.RIG PHONE                  EXT:
             93. TRANS DEST     PHO.NT                 EXT:
     94. ETA ORIS NW(DATE/TIME): 000                                                95. ETA DEST KTF(DATEfTIPC)- 000
             97. @.ER CE.@:



             !!. ?,S.N #: 0000/001                                                          52. ROI Lr@:
             57. VA'-IDATED BY/REAS FOR HIGHER PRECEDENCE:
             96. 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