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File: 092496_aug96_decls4_0009.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
.6:'L5:16 PATIENT FILE +Hf 01/04/91
PERSO,W@ DATA - PRIVACY ACT OF 1974
5 U.S.C. 552 (b)(6)
13. MODE: A
1. NAYE: 18. WJTHCRITY #: 1002AOB4 2. Sk,4:@ S. PRECM-CE- R
4. STAT: All 5. GRADE: E06 6. ABE: 37Y 7. SEX: X S. WT: 188 9. READY DATE: 2
12. SPEC CAT:
.0. ISO., 11. POR:
14. REAS REB: DS 15. DATE LAST VISIT: 16. UM: 3A
17. ACCEPT PHYS: 19. APPT/SLRB DATE,. NO
20. AI.IPROY AUTH-. 21. CA.%C/lPr@: 22. VALID: itr, Y5
23. KTF ORIG: A5150 USA DISPENSARY DKMN 24. ICAO CRIS: M
25. NV DEST: F5070 MMC WIESBADEN GE 26. ICAD DEBT: EDA7
27. MED SPEC It SOOL M. DIAG 1: 7242 LLMAM
29. Ka SPEC 2: 30. DIAS 2:
S 3.o
32A. PROCEDL;RE:
35. SPEC DIET. NI 34. IV:
35. 02/LPM: N 1 36. sn. : N 37. N@o TUBE: N 38. RESP: N 39. FMZ: N 40. STRYKER:
4'.. IM: N 42. TRAP.T. N 43. IYZD: N 44. CAST/LCE: N 45. TRACH: N 46. MO.4, N
71. PT BAG TYP-mi NB 72. PT BAG TAG 73. PT BAB WT-.
47. SUPP INFO: 8 ORD IST CMMM, Fr BRAbri, 14C //44 PB//
//28 CSH//
48. TAX EKRTE STOPS: Y / 9 49. FAX 0 RGNST Y / 9 50. ALT REST/14AX HI: N
53. INPA71ENT: Y 54. SPEC PRCS: VA DRLIS ALCOHOL WT NOE X 55. VA CODE:
56. ADMIN/@EAS:
53. VITA. SIM(TEMP/PLILSEIRESP/B'ADD PRESS): 098.2 88 / 20 / 112 70
59. HGBT 60. HCT: 61. ABS: DATE TAIA:
62. 6B6: 63. SI/VSI: 64. REDICATIO\'S: NX
65. HISTORY: CHRONIC LBP. NOT RESMNSIVE TO TREATPM. HILD ARThRI71S.
65. ATT PHYS: JOiNST0.11@ 67. PHI: 999 999 9999 66. WARD#/PHI: 999 / 999 999 9999
69. REPORTED BY: SST ABBOTT 70. PHI: 999 9999
76. GRADE:
77. AGE-. 78. SEX- 78A. WT. 79. RELATIONSHIP TO PATIENT:
EO. BAG TYPE: 81. BAB TAB 82. BAG WT-
83. ATTENDANT NAME #2: 84. STATUS: 85. BRADE:
26. AGE: 87. SEX: 87A. W'T: 88. RELATIONSHIP TO PATIENT:
69. BAB TYPE: 90. BAG TAG 91. BAB WT:
92. TRANS CRIS PHO\'E EXT:
93. TRANS DEST PHOIC EXT:
94. ETA CRIS MTF(DATEtTIrE): 000 95. ETA DEST MTF(DATE/TIKE): 000
97. OTHER
5'.. :,&N #: OW/002 52. RC'4 LOC:
57. VLIDATED BY/REAS FOR HI P
96. AIRCRAFT ITIONY.-
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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