PERSONAL DATA PRIVACY ACT OF 1974 4 JAN 91

File: 092496_aug96_decls4_0007.txt
Page: 0007
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








                   .6:14.42                                        "H PATIEN@ FILE                                                  01/04/91
                                                          PBMNAL DATA - PRIVACY ACT C-F 1974

                                                                            5 U.S.C. 552 (b)(6)
                                                                                                                               13. lg.DDEs A
                                                                  18. AUTHCRITY #: 1002AO52 2. SSM                             3.  PRECEDDICE: R
               NA.@:
               4. STAT: All             5. Mr: E02                6. ASP: 19Y          7. SEX: M              S. VT-  160      9.  READY DATE:         I
               10. ISO-                 11. POR.                                                                               12. SPEC CATs
               14. REAS REB-            DS 15. DATE LAST VISITT                                                                16. CLASS: 3A
               17. ACCEPT PHYS:         JxjM
                                                                                                                               19. APPT/SLRB DATE: NO
               20. APPRGV AUTH:                                                      21. CfLN@'/IN.:                           22. VA'- I D:               il*.C   Y3
               23. KW CRIS: A5150       LTEA DISPENSARY DPAIMN                                                                 24. IC.40 CRIS:     GEDR
               25. Kre DEST: A5040      ZIM GEN FASP LAUSTL3.L                                                                 26. ICAO DM.        EDAR
               27. ra SPEC 1: KvA       28. DIAS 1: 9950               CTIC SHOCK, N,3T ELSEWRM CLASSIFIED
               29. rED SPEC 2:          30. DIAS 2:
               31. 11,ED SPEC 3,.       32. DIAS 3:
               32P. PROCEDURE:
                        34. IV:
               Y3. 02/LPM: N            36. SLI.7: N         37.  NB TUBE: N         38. RESP: N                          39.  FUM:         N     40. STRYKB: N
               41. I%'DM:               N42. TRACT: N        43.  lrED: 'i           44. CAST/LUC: N                      45.  TRACH.       N     46. M3N. N
               71. PT BAB TYPE: t@                           72,  PT RAS TAG                                              73.  PT BAB WT:
               47. RIPP IWO:            IST DIV IST INF -LO:ATIG.N L%Mk'.4 //SM EVAC//

               48. VAX EN.RTE STOPS: Y / 9                   49.  rAX # RON'S: Y       9                                  50.  ALT REST/KAX HT: N
               53. INPATIENT: Y         54. SPEC PRCS:    VA      DRUG      ALCDHCL       WT     N@ X                     35.  VA CODE:
               55. AD.IIN/BVERSEAS:                I
               59. VITAL SIGM (TEKO/PUMRESP/B;-GM PRESS)., 098.5                  100     IS /    132         84
               59. HGB:                 60. ICT:            61. ABB:                                          DATE TAIO:
               62. WBC:                 63. SI/VSI-.        64. M:DICATIO.NS. ATikRAX 25.n TID, EPITURIKE PIL4




               65, HISTORY: LIRTICA.RIA WITH DESERT CKFLAGE SUBSELBT LIRTICARIA DIFFUM
               29 DEC 90 THP44 31 DEC 90 DESPITE BENADRYL tLl@ PRENDISC)r-. D-@PED EDEMA
               4ND MMIAL SPASM. REQUIRES           ERRSENT EPINU"INE, REDUIRES ALLERGY EVAL







               66. ATT PHYS., SALE                 67. PH#: 473 857 3844                                      68. NARD#/PH#: 738 / 473 847 3M
               69. REPC-RTED BY: DRt@                                                                         70. PH#: 473 8574
               74. ATTBMAt4T NW #I:                                                                           75. STATUS:                      76. SME:
                  79. RELATIO.NSHIP M PATIENT:
               eO. BAB TYPE:                       St. BAB TAB                                                82. BAB WT:
               63. ATTBM4T              NFLME 12:                                                             84. STATUS:                      85. GIZADE:
               26. A3E:                            87. SEX:                 87A. WT:                          88. RELATIONSHIP TO PATIENT:
               89. BAB TYPE:                       90. BAB TAB                                                91. BAB Wr:
               92. TRA%'S CRIS          PHC.'IE          EXT:
               93. TRA.NS DEST          PHONE            EXT:
               94. ETA CRIG MTF(DATE/TiFe): 000                                                               95. ETA DEST tff(DATEtTIVE): 000
               97. OTHER CO.@-.



               51. '.%N 0: ODOO/001                                                                           52. RON LOC:
               57. VA-IDATED BY/REAS FCR HIGHER PRECM:E-                1
               96. AIRCRAFT ITINEMY,

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