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File: 102896_aug96_decls1_0004.txt
Subject: PATIENT FILE 29 OCT 90
Box ID: BX000482
Unit: ARCENT
Parent Organization: CENTCOM
Folder Title: MEDSTAT - SITREPS OCT 90 3 OF 4
Folder SEQ #: 16
Document Number: 10
06:f@6:43 PATIENT FILE 10/1@9/90
PERSCNIA DATA - PRIVACY ACT OF 1974
13. @'@ODE: A
1. NAV@E@ 18, AUTHORITY #: 0299AOO6 2. SSAN@ 3. PRECEDENCE@ R
4, 97,AT: Fit 5. GRADE: @06 6. ABE: 42Y 7. SEX: im S. WT: 150 9. READY DATE@ 299
10. 160: 11. POR. 12. SPEC @@AT:
14, REAS REO.- DS 15. DATE LAST VISIT: 5 U.S.C. 552 (b)(6) 16. 'CLASS; 'zA
17. ACCEPT PP@YS: 19. APPT/SURB DA@IE: NO
20. APPRUV AUTH: 21. P@Ai\!F@/INC: 22. VA!-ID: CEA Y4
2@@ @11TF OR-IG: A5150 USA DISPENSARY DHAHRAN' 24. ICAU ORIG; OC@DR
z5. llit DEST; A5040 ' DGc HOSP LA,.NDET'u'Hi 26. ICAD DEST: EDAR
,F LN
27. iMc-Tl SPEC I-. McmC 28. DIAS l@ 78650 UNSPECIFIED CHEST PAIN
29. ric@D SPEC I.: 30. DIAG 2:
31@ r@'@-D SPEC @ 32, DIAG 3:
72A. PROCEDURE:
33, SPEC DIET-, Y/NONE 34. IV:
TRYKER: N
,7
41. INCUB@ k 42, TRACT: N 43. liv,@ED: N 44. CAS-i/LOC: N 1 45. TRACH: N 46. i4lDiN': N
71. PT BAG TYPE: NB 72@ PT BAG TAG @t 73. PT BAS WT:
47. SUPP INFOI LANGLEY AFB VA I ATH P
DTORITY **
46. MAX EN.RTE SDPS@ Y / 9 49@ MAX # RONIS: Y 9 '@O@ ALT REST/MAX HT: N
Iz@ INPATIENT: Y @@4. SPEC PRM-@ VA DRUG ALCOHOL 'AT -NONE X 55, VA CODE:
56. ADMIN/OVERSEP.9;
58@ VITAL SIGNS(TEt',P/PL'LSE/RESPIBLOOD PRESS): 096.8 64 16 128 64
59. HGB: 60. HOT: 39% 61. ABG: DATE TAKEN':
62. 1,4BC: 6 63. SI/VSI: 64, NIEDICATIONIS: 'INDERA MG I
L AL @o 64, NITIRC@DPSTE 1 !NO
Q6H 02 4LITERS CO'@A@uE 100 MG OD L4,EPARIN 5000 60 BID ASA 3@j MG OD
65@ HISTORY: ATYPICAL CHEST PAIN. Vil RULED OUT NO FURTHER CHEST DAIN NO DYSRYTH
VIA NEEDS TREADMILL EXERCISE TEST, SPECIALTY NOT AVAILADLE IN ACR.
66@ A-IT P'IYS: JA@@OBSON 67. r'h'#: 000 000 0000 68. NIARD#IPH#: 000 000 000 0000
69. REPORTED BYt tiSST iMikRTI@ 70. PP@#: 000 0000
74. ATTENDANT NAME #lg WADDELL FRANK 75. STATUS: Fit 76. GRADE: 005
I 76A. WT: 200 79. RELATIONSHIP TO PATIENT: N
SO. BAG TYPE: t%B 81. BAG TAG 82. BAG WT:
83@ ATTENDANT MAHF *2: 84. STAIUS: B@.. GRADE@
96@ AGE, B7. SEX: 67A. 'WT: BB. RELATIONSHIP TO PATIENT:
89. BAG TYPET 90. ',OAS TAG 91. BAG WTt
9@4. RAiN,S 0016 PHONE XI:
9i. TRANS DEBT EXT@
94. ETA D@TG i@TF(DA-IP/T@,E)@ 000 95, ETA DEST @,TF(DATc/TIiIE)@ 000 I
97. 0-1p@c,R @60@tric@tlTS-.
@l
-@SN #: 0000/299 5'4. RON LO@@:
57. VA@TDA7 D BY/REP.S FOR HIGHER PR@ EDEN'
-@ E @E
96. AIRCRAFT ITINERARY@ I
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Document 46 f:/Week-32/BX000482/MEDSTAT - SITREPS OCT 90 3 OF 4/patient file 29 oct 90:10019616503417
Control Fields 17
File Room = aug96_declassified
File Cabinet = Week-32
Box ID = BX000482
Unit = ARCENT
Parent Organization = CENTCOM
Folder Title = MEDSTAT - SITREPS OCT 90 3 OF 4
Folder Seq # = 16
Subject = PATIENT FILE 29 OCT 90
Document Seq # = 10
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 = 01-OCT-1996