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File: 102896_aug96_decls1_0042.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
07:23:716 **** PATIENT F,LE **** 10/29/90
PERSONAL DATA - PRIVACY ACT 1974
1 @VIODE; A
1. 18. AUTHORITY #: 03OIA012 2. SSAN: - PRECEDENCE: R
5. GRADE@ 002 6. AGE: 23Y 7. SEX; I S.
4@ g-,,A'; All , READY DATE: 30(l,
10. ISO: 11. POR: 12. SPEC CAT: f
14. REAS RES: DS 15. DATE LAST VISII: 5 U.S.C. 552 (b)(6) 16. CIIASSI 3A
17. ACCEPT F'PYS: 19. A.PPT/SUR.G DATE: MD
20@ AEPROV AUTH! 21. @@AN-@/T@C: 22. VALID: IM.LE Y7
23. MIF DR!GZ A5!50 USA DISPENSARY DHAHRAN 24. IP@AO ORIS: OEDR
O@6. ICAO DESTI C@DAR
27, Vi@,D SPEC Ml@il 28. D'@Alo li 460 CLASSICAL MIGRAINE
29. ,DIED SPEC 2! DIAG 2:
l@ @,ED SPEC 3: 32. DTAC
329.
33. SPEC DIET: N/ 34. TV:
35. 02/LPti,. N 36. SLI'@T: 37. NS TUBE: N 38. RES@: Nl 39. FOLEY: N 40, STRYKER: N'
4i@ IN" B: t\l 42, TRACTT N 43@ IMED. N 44. 1
4u @AST/1,00: N 4@@. T@ACHI N 46. MON: ,4
@ll
71. PT BAG TYPE; NB 72. PT BAG 'AG 7'@. PT BAG @IT:
47. SUPP INFO: A COMPANY 224T@l SUPPLY, FT STORY VA *******DS
48. h'iAX EN@RTE STOPS: Y 1 9 49. MAX '@ RONS@ Y 9 50. ALT REST/F@AX RT: N
5,-@. @@'PATIENT@ Y 54. SPEC PRD'G; VA DRUB ALCOHOL WT NONE X 55. VA CODET
56. ADMIiN/@UVERSI:AS@
58. VITAL STO
C.N '2 ',B 1 72
@ S(TEMP/P'U'LEE/RESP/B'@OOD PRESS): 098,0 68 I i
61). 'HCT; 61. ABG: i DATE TAKEN;
62. WB'4: 63. SIIVST: 64. MEDICATIONS: @JOTRIN 600 rG @00 TID
65. HISTORY; HISI OF CON31NI,'All MIGRAINES, INDICATED SEVERAL EPTSODAS OF
UNCONSCIOUSNESS, NO-, FIT FOR DUT , I C T BODE WELL Wl-' -@--SED W/ POST CON;7-JSSIO
.Y @ -PI iN
66. A.-IT PHYSI MORTE 67. PH#: 000 000 0000 68. @IARD4/PH#: 000 / 000 000 0000
69. REPORIED BY. HERRc@eANS 70. PH@,: O(KI 0000
14@ ATTENDANT NAME 75. STATUS: 76. GRADE:
77. Ar,'E: 78. SEX: 78@A, @IT: 79. RELAT TONSHIP TO PATIEN Tj
00, BAB I-YPE- 61, BAG TAG 82. BAB t4T;
G3. AT-) ENDANIT NAME #'L; 84. E-IA@T IU: 85. GRADE:
86. ASE@ B7. SEX: 87 A. F!: 88. RELATIONSHIP TO PATIENT@
89. BAG TYPE: 90. BAG TAG 91. BAG @IT:
92. TRANS ORTO PH.C.,\IE @l EXT:
9 . TRANS DESI PHONE EXT-.
95. ETA DESI MTF(DATEITIVi@-)2 000 1
97@ OTHER Cn,@-MENTS@
51. '@: 0000/@100 52. RON !LEE:
57. VA.',-IDA.TED BY/REAS FOR HIGHER PRRICEDENICE@
96, ATRCRAR@T ITINERARYZ
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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