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File: 102896_aug96_decls2_0004.txt
Subject: PATIENT FILE
Box ID: BX000482
Unit: ARCENT
Parent Organization: CENTCOM
Folder Title: MEDSTAT - SITREPS OCT 90 3 OF 4
Folder SEQ #: 16
Document Number: 6
04:40 PATIENT FILE 10/22/90
PERSONAL DATA - PRIVACY ACT OF 1974
5 U.S.C. 552 (b)(6) 13. NODE. A
1. NAME. 18. AUTHORITY 029OA026 2. SSAN- 3. PRECEDENCE: R
4, STAT: All 5. SRADE. E05 6. AGE: 33Y 7. SEX: M 8. WT: 185 9. READY DATE: 290
10. ISO@ It. POR: 12. SPEC CAT-
14. REAS RES: DS 15. DATE LAST VISIT: 16. CLASS: IC
17. ACCEPT PHYS: JMRO 19. APPT/SURB DATE- NO
20. APPROV AUTH; 21. CANC/INC: ??. VALID- SMF Y7
23. MTF GRIG: A5150 USA DISPENSARY DHAHRAN 24. ICAO GRIG: DEDR
2@@. )ITF DEST: A5030 FRANVFURT ARMY REG NED 26@ ICAD DEST: EDAF
27, MED SPEC I- MPPG 2B. DIAG 1: 3099 UNSPECIFIED ADJUSTMENT REACTION
29, MED SPEC 2: MPPO 30. DIAS 2: 2978 OTHER SPECIFIED PARANOID STATES
31. NED SPEC 3: 32. DIAG 3;
32A. PROCEDURE.-
33. SPEC DIET: N/ 34. IV:
35. 02/LPM: N 36. SUCT- N 37. NG TUBE: N 38. RESP: N 39. FOLEY: N 40. STRYKER: N
41. INCUB: N 42. TRACT- N 43. IIIED: N 44. CAST/LQC, N 45. TRACH- N 46. MON: N
NB 72. PT BAG TAG 73. PT BAG WT:
47. SUPP INFO: 514TH MAINT CO, FT. DRUM NY
48. MAX ENRTE STOPS: Y 1 9 49. MAX # RONS: Y / 9 50. ALT RESTIMAX HT: N
. INPATIENT- Y 54. SPEC PRM., VA DRUG ALCOHOL WT NONE X 55. VA CODE:
56. ADMTN/GVERSEAS:
58, VITAL SIGNS(TEMP/PULSE/RESF/BLOOD PRESS): 000.0 I
59. HGB: 60. MCI- 61. ARG.- DATE TAKEN:
6'4. NBC: 63. SI/VSI: 64. MEDICATIONS: N
65. HISTORY- PT NERVEOUS AND JUMPY, NO SUIDICAL INCLINATIONS, NO HALLUCINATIONS,
AND SUPERVISOR IS CONCERNED DUE INABILITY TO CONCENTRATE AT JOB. RECOMMEND
EVAC OUT OF AOR.
66. ATT FHYS: LTC STEINWEG 67, PH#: 000 000 0000 68. WARD#/PH#: 000 / 000 000 0000
69. REPORTED BY: GUIDO 70. PH#. 000 0000
74. ATTENDANT NAME #I- 75. STATUS- 76. GRADE:
77. AGE: 78. SEX: 78A. WT- 79. RELATIONSHIP TO PATIENT-
80. BAG TYPE- 81. BAG TAG 82. BAG WT:
83. ATTENDANT NAME #2: 64. STATUS-. 65. GRADE:
86. AGE- 87. SEX. 87A. WT. 88. RELATIONSHIP TO PATIENT.
89. BAG TYPE- 90. BAG TAB 91. BAG WT.
92. TRANS DRIG PHONE EXT:
93. TRANS DEST PHONE EXT:
95. ETA DEST MTF(DATEITIME): 000 1
97. OTHER COMMENTS:
51, MSN 52. RON LOO:
c
@7. VALIDATED BY/REAS FOR HIGHER PRECEDC E.
96. AIRCRAFT ITINERARY: I
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Document 41 f:/Week-32/BX000482/MEDSTAT - SITREPS OCT 90 3 OF 4/patient file:10019616503518
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
Document Seq # = 6
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