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File: 102896_aug96_decls2_0005.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)
1. NAME: 18. AUTHORITY 029OA027 2. SSAN-.NM 17@ .MODE: A
3. PRECEDENCE: R
4. STAT: All 5. GRADE- E05 6. ABE: 25Y 7. SEX: M S. WT: 230 9. READY DATE: 290
10. ISO: 11. POR-. 12. SPEC CAT:
14, REAS REG: DS 15. DATE LAST VISIT: 16. CLASS: 3A
17. ACCEPT PHYS: JMRO 19, APPT/SURB DATET NO
20. APPROV AUTH: 21. CANC/INC: 22. VALID: SMF Y7
23. MTF GRIG: A5150 LISA DISPENSARY DHAHRAN 24. ICAD BRIG: DEDR
2-3. MTF DEST: A5040 2ND GEN HOSP LANDSTUHL 26. ICAD DEST: EDAR
27. NED SPEC 1: SCOH 28. DIAG 1: 81600 CLOSED FRACTURE OF PHALANX OR PHALANGES OF HAND, UNSPECIFIED
29. NED SPEC 2.- 30. DIAG 2:
31. MED 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
B: N 42. TRACT- N 43. IMED: N 44. CAST/LQC: N 1 45. TRACH,. N 46. MON: N
71. PT BAG TYPE: NB 72. PT BAG TAG 73. PT BAG WT:
47, SUPP IWO: A CO 319TH i4l, ISTH ABN CORP
48. MAX ENRTE STOPS: Y / 9 49. MAX # RONS: Y / 9 50. ALT REST/MAX HT- N
5'@. INPATIENT: Y 54. SPEC PROS: VA DRUG ALCOHOL w@ NONE X 55. VA CODE,.
56. ADiIIN/DVERSEAS-
58. VITAL SIONS(TEMP/PULSE/RESP/BLOOD PRESS): 000.0
59. HGB- 60. HCT: 61. ADS- I DATE TAKEN:
62. WBC: 63. SI/VSI: 64. MEDICATIONS. TYLENOL III I TO 3 TABS EVERY 3 HOU
RS.
65. HISTORY: 13 OCT FINGER CAUGHT IN FAN OF VEHICLE. 14 GET PT HAD BURG FOR DON
E AND TENDON REPAIR. NO CAST OR SPLINT. SURG DONE AT 28TH CSH.
66. ATT PHYS- STOWELL 67. PH#- 000 000 0000 68. WARD#/PH#-. 000 / 000 000 0000
69. REPORTED BY: LCDR 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 92. BAG WT-
. ATTENDANT NAME #2: 84. STATUS- 85, GRADE:
86. ABE-. 97. SEX: 87A. WT: 86. RELATIONSHIP TO PATIENT,
91. BAG WT:
92. TRANS ORIS PHONE EXT:
91 TRANS DEST PHONE EXT:
94, ETA ORIS iMTFIDATE/TIME): 000 1 95. ETA DEST KTF(DATEITIM@E); 000
97. OTHER COMMENTS:
51. MSN 52. RON LOC:
57. VALIDATED BY/REAS FOR HIGHER PRECEDENCE: I
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