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File: 102896_aug96_decls1_0045.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
07:24:43 **** PATIENI FILE **** 10/1@9/00
PERSONAL DPT - PFIVAP ACT OF 1974
.A @y
RODE: A
'8. AUTH @@y #t 07OIA004 z. SSAN: 3. PRECEDENCE: R
4. STAT: ),ii 6, ABc-@ NgY 7. SEX: 8. 9. READY DATE: 300
1 @@ UFRD : - , -Wu '
10. ISO@ II. POR@ 12. SPEC CAT:
14. RC@AS RES: DS 15. DAIE LAST VISIT: '6. CLASS: 3A
5 U.S.C. 552 (b)(6)
17@ ACCEPT PHYST 19. APPT/SURO DATE: NO
20. APPROV AUTH: 21. CANC/!KPI: 22. VALT@ MILE Y3
2-3. M7F ORTC; A51@ USA DISPR @ RY DHAHRAN 24. !CAO CRIB: OEDR
@o @N-A
GEN '@4.080 LANDSTLIH@L 26. IC-AG DEST: EDAR
.F I
27@ @IED SPEC l@ Vilii%' 28. DTA3 It 7242 LUMBAGO
29. '!ED SPEC 2. 30. DIAG 2:
31@ M@c,D SPEC 3: 32. DTA' 3:
32A. PROCEDL'Rc@@
33. SPEC DIET. N/ 34. IV:
354 02/LP@i,. N 36. SUC-I; 7,. NO TLIPE: N 38. RESP@ N' 39, FOLEY: N 40. STRYKER@ \1
41. N42. IRAP@T: N 43. IiyiED: N 44. CAST/LO'U: N 4i. iRA'@H: N 46. N
71. PT BAD TYPE: NB 72s PT BAD TAG t@k: 73. PT BAG WT:
47. SUPP INFO: FT CAVIPBELL, KY RP-PORIED BY!
@BTPI CSH
4B: MAX L@,IRTE STO@S@ Y / 9 49. MAX # ROINS@ Y 1 9 50. ALI REST/MAX HT: i'i I
5L Tt,'PATIENi@ Y 54@ SPEC PRG'U@ VA DRUG ALCOHOL 14'T NONE X 55. VA CODE:
56.
@8@ VTIA SIG,\iS(-, MP/PULSc/RESP/DLOOD PREQ ): 098.6 85/16 140 1 70
@E -S
59@ li"ub: 60. HOT: 61, ABS: DATE iA@KEN!:
62. 63. SIIVSI: 64. MEDICATIONS! T'uLE'@Tli\'- DS/ 4 X DAY
6@'. PISTO.RYT 38Y 4'.A',E LONG HIST 0;7 LO@JER BACK PAIN, DC,VELOPED SIGNS OF L@5
Tt RCLF@ 3-i . RADICL.'LPO THY DIJRTNO THE LAST MDN-H, HAS NOT IMPROVED W/
i,. 4. oH, @t A I r
N,GNSERVITTVF MA@NASEiMc@N'T@ CTS & NEUROLOGY CONS7dLT REQU@ ED,
EST
66@ ATT PP@YS: SCHMIDT 6'@ P4 : 000 000 0000 68. WARD#/PP,@: 000 I OfiO 000 @@000
69. REPORI,@. BY@ H.'CRRc,r.,AIE 70. P@q#-. 00%1 0000
74@ ATTarNDANi NIA'Ocl #I: 75. STATUS: 76. 'URADE@
I 79. REL IONSHIP TO PATIENT:
,7. AGE: 78. SEX: 78A@ WT; ATT
O.O. BAG TYPE: Bl@ BAG TAG 82. BAD @',4T:
8@@. AIT NIDANT NAME "t2; 84. STATUS: 85. CRAD;::
,E
86. AGE: 87. SEX: 97A. WT: 88. RELATIONSHIP TO PATIENT:
69. BAG TYPE2 90. BAG -IPG 91. BAG WI;
92. TRANS ORIG PHONE 0: EXT:
93. -IRANG DEST PHONE #. "XT:
/Tlr,C): 000
95, ETA DEST MTF(DATE/Ti@IE): 000
97@ OTHER COMMENTS:
51. MSINI #; 00001300 @@2. RON LOC:
57. VALIDATED BY/R;-7AS FOD PRECEDENCE:
CRAFT I @ _R
96. AIRP c; 7T'\,;: ARY: 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