PATIENT FILE 29 OCT 90

File: 102896_aug96_decls1_0044.txt
Page: 0044
Total Pages: 46

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




             07t24:12                                                PAT,@'T FILE                                                10/29/90
                                                                        . . @tN
                                                      PERSONAL DATA - PRIVACY ACT OF '974



                                                                                                                           13. V.,OD-t: A
             A
             N                                                 18. AUTHORITY #: 029BA049 2. SSANT                          3.  PRECEDENCE: R
      4.     SiAl: All             5.             a            6. AGE: 23Y           7. SEX@ M          S. WT@     175     9.  READY DATE: l@98
      10,    ISO-                  11. PORI                                                                                12. SPEC CAT:         1
      14.    REAS REG: DS          15. DATE LAST VISIT:,5      U.S.C. 552 (b)(6)                                           16. CLASS: 3A
      @7.    ACCEPT PHYSI                                                                                                  19. APPT/SURG DATE: NO
      20.    APPROV AI.ITH.:                                                         21. CANC/I.N'Ci                       22. VALID:                   LiviK  Y4
      23,    @"iTF C'RIG.- A5150   USA DISPENSARY DHAHRAN'                                                                 24. ICAD BRIG:        GEDR
      25.    MiF DEST- A@1030      F@RAN'FLIRT ARMY R-Fa MED                                                               26. ICAO DEST:        EDAF
      27@    V@ED SPEC '-- 600,-28@ DIAS 1: 71783       OLD    DISRUPTION BP ANTERIOR CRU@@IATE LIGAMENT
      29.    MED SPEC 2:           31). DIAS 2:
  ,-,31@     MED SPEC 3:           32@ DIAS 3i
      2A@ PROP,EDUPP:
         . SPEC DIET:     N/                                                         34. IV:
RESP; Ni                     39. FOLEY:            N    40. STRYKC,R: N
      41.    'IN@@LIB:  i%'@       42. TRACT: N         43.    IrtED@ N              44. CAST/LGC@ iN                 45. TRACH:            N    46. MON: %t
      71.    PT BAS -iYPE,. NIB                         72.    PT BAD 'AS                                             73, PT BAS WT@
      47,    SUPP INFO,, FORT      DEVON, iMS                                                                REPORTED BY
      61','B-AREA
      48.    MAX ctNRTE STOPS4 Y / 9                    49,    MAX @ @RONS: Y        / 9                              50. ALT RESTIrtAX @9T@ N
      53.    !NPAIIEN-1: Y         54@ SPEC PROS:     VA       DRUG      ALCOHOL       4T      NONE X                 55. VA CODE:
      56.    AD/ti'il/DVERSEAS.
             VITAL S16NS(TEM@O/PU',SE/ric@bP/BLOOD PRESS): 077@6                     60 /20    110      60
      59.    92B:                  60@ HCT:             61. AEG-                       I       I        DATE 'A@Et@'t
      @2.    NBC:                                       64. MEDICATIONS Noki
      c                            63, ST/Vgj:                                       ME




      65.    'H@ISTO,-,Y@ CHRONIC INSTA371-l'y OF LEFT KN- X 14 i@'!ONTL6.
                                                               -E   ,










      66@    ATT P YS: TERIES                     67. OL": 000 000 01100                             68.  @!ARD'/PH#! 000 I 000 000 0000
             . H            ..I\                                                                              t?
      69,    REPORTED BYt ViARC@@'PNT                                                                70.  P@'A#: 000 0000
      74,    ATTEII@@AN-i NAMP- 4.@-z                                                                75=  STATUS:                           76, GRADE;
      77.    AGE:                                 78. SEX;               781.i. WT@                  79@  RELATIONSHIP TO PATIENT:
            81. @:A'u TAG                                      82,  BAG WT:
      63.    ATTENDANT  NAME @2-.                                                                    84.  STATUS:                           85, GRADE:
                                                      c
      66.    ASc@!                                87. SEX;               87A. WT:                    88,  RELATIONSHIP TO PATIENT@
      69.    BAG TYPET                            90. BA,@@ TAo                                      91.  DAL' WT:
      92.    TRANS ORIG PHONE                         @-XT:
      93.    TRANS DEST PHONE                         EXT@
      94.    ETA ORIN@ MTF(DAT@-/Tl@,F-): 000 I                                                      9,q. ETA DEST mTF(DATE/II-ME): 000
      97.    OTHER COMMENTS:



      51:    @ISN #; 0000/298                                                                        52@  RON LO@@:
      57@    VALIDATED BY/REAS FCR HIGHER PRECEDENCE:
      96.    qlRCRAF    TITINERARY:                            I

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