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File: 092496_aug96_decls4_0008.txt
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,.14:56 PATIENT FILE 01/04/91
PEMIOL DATA - PRIVACY A-7 OF 1974
5 U.S.C. 552 (b)(6)
13. MODE., A
1. MIIE- 18. AUTHORITY 1. 1002ADBO 2. sskq..@ 3. PRECEDENCE- R
4. STAT: All 5. G.RADE- E02 6. Ail: 19Y 7. SEX: M B. WT: i65 9. READY DATE: 2
11. PCR.- 12. SPEC CAT.-
.0. ISO:
14. REAS RES: DS 15. DATE LAST VISIT: 16. CLASS: 2B
17. ACCEPT PHYS: 19. APPT/SURG DATE: NO
20. A.IIPROV MM- 21. CA.NC/IN@P. 22. VA-ID: J?I.C YS
23. NU CRIS: A5150 LISA DISPENSARY DFA@4 24. ICAO CRIG: =
25. MU DESTI F5070 LISAFRMC WIESBADEN GE 26. ICAO DEST- EDA7
27. M.ED SPEC 1: SOO 28. DIAB I.- 8360 TEAR CF RZIAL CARTILAGE OR WNS-NB OF M ,
29. rEl) SPEC 2: 30. DIAS 2:
31. tlED SPEC 3: 32. DIAS 3:
32A. PROCEDURE:
33. SPEC DIET: W 34. IV:
31-. : N 36. %7. N 37. NG TUBE: N 38. RESP: N 39. FCLEY: N 40. STRYKER: N
- N42. TRACT: N 43. 1?0: N 44. CAST/LCC: N 45. TRACH: N 46. MCN.- N
7!. PT BAG TYPE: 0 72. PT BAB TAB 73. PT BAB WT-
47. SUPP I*M: A CO 3/M5 INF, FT BRASS, NC //44 ra//
/ICF.AMP RAINII
48. @@AX E?u'M STCni Y / 9 49. KAX # RONS: Y 9 50. A'-T REST/PAX HT: N
53. INPATIENT: Y 54. SPEC PROS: VA DRUG ALCDHV@ 6'T NONE X 55. VA CODE.
56. ADMIN/
59. VITA@ S16.%(TEPP/PLf-SE/RESP/BLCDD PRESS): 097.6 / 66 16 / 132 / 72
59. HSB: 60. HCT: 61. ABG,. I DATE TP.KEN:
62. WBC: 63. SIIVSI: 64. ROICATIONS: NONE
6,5. HISTORY: ONE V.3.qM SINCE PATIENT HAD PARTIAL FFDIAL ?BISEMIN. PATIENT FE
'@@ OLRINS POSTCP. RE IMRTHOIS. DRNSE OF COMMAND REGUIRE EVAC AO
R. PATIENT MAY NEED ?RB OR REPEAT A.R Y.
66. ATT PHYS: COF.PTr.14 67. PR#: 999 999 9999 68. WPM#/PH#: 999 / 999 9" 9"9
69. REPORTED BY- SST ABBOTT 70. PHO: 999 "99
74. ATTENDANT NAME #I: 75. STATUS: 76. GRADE:
77. AGE: 78. SEX: 78A. WT: 79. RELATIOHSHIP M PATIENT:
20. BAG TYPE: 81. BAB TAG 82. BAB WT:
S3. ATTENDANT NAME #2: 84. STATUS: 85. GRADE:
87A. WT: 88. RELATICISHIP TO PATIENT:
89. BAB TYPE: 90. BAB TAB 91. BAB WT-
9'2. TRANS CRIS Pir.,@ EXT-
93. DEST PHONE EXT.
9,. ETA CRIS KTF(DATEITIF.E): 000 95. ETA DEST KTF(DATE/TlKt-)- 000 1
97. OTHER CRV.WS:
5!. ),.S.N #: 0000/002 52, RON LOC:
57. V@-IDATED BY/REM FOR HIGHER PRECEDENCE:
96. AIRCRAFT ITINERARY,.
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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