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File: 102896_aug96_decls1_0005.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
06:4i:02 PATIENT FILE 10/29100
PERSONAL DATA PRIVACY ACT OF 1974
VIODE; A
1, klArF-: m 16, 4L'TKORITY @: Oz'99AO50 2. SSA@,': PRECEDENCE: R
4. STAT@ All 5. GRADE: @106 6. P@9E@ 48Y 7. SEX: i@i S. '@IT: 205 9. READY DATE: 297
io@ 160@ ii. POR; I 12@ SPEC CATT
14. R@cAS REG; DS '5@ DATE LAST VISIT: 5 U.S. C. 552 (b)(6) 16. P@LASSI 2B
i7. ACCEPT OHY6-. JMRO t9. APFT/SURG DATE: 00
2'@)@ APPROV fVdTH. 21. CAiNC/IN'@: 22. VAL T Di I I Lr@K Y7
2-,. @,TF ORIS: P@5150 USA DTSPE\ISP.RY DhA'rR4i\l 24. TCAD OR'G: OEDR
25. IF DEST,@ 45030 FRANKFURT ARMY REG Mc 26. ICAD DEST: EDAF
ED
D
29. Mc,D SPEC 2: 3'y@ DIAS 2:
31@ riED SPEC -o- 7@2@ DIAS 3@
'@2A, PROCEDURE:
SPEC DI;-:Tt I/ 34. IV:
3i, 02/LPM: %@ / '@6. SUCT@ N 37, NG TUBE: N' 36@ RESP: N 39. FOLEY: N- 40, STRYKER: N
41. INICUB. N 42. TRACTI N 43@ li@@ED: N 44. CAST/1-OC: N 45@ TRAC@4- N 46. MON! N
71@ PT BAB TYPE. ME 72. PT BAG TAG #t 73. PT DAB WT:
47@ SUPP INFO: 704 TRANS DET FORT DC@VENS, MASS REPORTED BY
28 @SH *****DDS***
49. MAX EI\,RTE STnpS: y / 9 49. MAX # ROK-S: v/ 9 50. ALT REST/@IAX @qT: N
53. LNIPATIENTT N @@4. SPEC PROG@ VA DRUB ALCOHOL WT NONE X
@5. VA CODE:
56@ A'@lri!N/DVPREEAS!
18, VITAL SIS@NS(TErP/PULSE/@RESPIBLOOD ORF-SS)@ 096@S / 90 / 18 130 / 90
@9. HB@,: 60. HCT@ 61, ABS: I I I DATE A@EN:
62. @'BC@, 6,-@. SIIVSI: 64. NEDICATIO@NIS: MOTRIN 800 MO BID
65, HISTORY:
LEFT FIED JA EI@SCUS TEAR. ARTHRITIC SIN'C@- 1986 '.4HEN PATIENT FIRST START- HAV
AL ED
INS PROBLEMS. CANNOT FUNCTION IN THIS ENVIRONMENT.
66, ATT @p@YS,. DR. ATCERICO 67. PH#; 000 000 0000 68. WARD#IPH#-. 000 000 000 0000
69. REPORTED BYz GUIDO 70. PH@: 000 0000
74@ ATTENDANI NAME 412 75. STATUS: 76. GRADE:
77. AGE t 76. SEX! 7BA. Wi: 79. RELATIONSHIP TO PATIENT:
80. BAG TYPE: 81. BAG TAG 82. BAB W'Tt
83. .4TiENIDANT NAME '@2: 64. STPI@S@ B@@. BRADcl:
86@ ABE; 87. ---EX; 87A. @IT-@ 89. RELATIONSHIP TO PATIENT:
89@ BAB TYPE; 90. BAB TAG 91. BAB WT-
92. TRANS ORIC PHONE EXT@
93@ TRANS DEST PHONE 4: 'EXT:
94, EiA GRi'u MTF@DA-[E/T7i@7)! 000 95. ETA DEST !ITF(DATE/TIME): 000
97. OT I COV-.VtFi%'TS:
,HcR
51, YJSN #@ 4"L3/299 52. RON LOC;
57. VALIDATED BY/,REAS FOR HIGHER PRECEDENCE:
96. AIRCRAFT ITINERARY:
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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