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File: 102896_aug96_decls2_0006.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
05:0-) PATIENT FILE 10/22190
PERSONAL DATA - PRIVACY ACT OF 1974
5 U.S.C. 552 (b)(6) 13. MODE- A
1. NAME 18. AUTHORITY 029OA005 2. SSRN-. @ 3. PRECEDENCE: R
4. STAT: All 5. GRADE- E05 6. AGE: 34Y 7. SEX,. M S. WT: 180 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: 19. AFPT/SURG DATE: NO
20. APPROV AUTHI 21. CANC/INC: 22. VALID- SMF I Y5
23. MTF GRIG@ A5150 USA DISPENSARY DHAHRAN 24. ICAD CRIB. DEDR
25. KF DEST: F5070 USAFRMC WIESBADEN BE 26. ICAG DEST: EDAF
27. NED SPEC 1: SOD 28. DIAG 1: 81401 CLOSED FRACTURE OF NAVICNA (SCAPHOID) BONP OF WRIST
29. NED SPEC 2: 30. DIAS 2:
31. NED SPEC 3@ 32. DIAS 3:
72A. PROCEDURE:
33. SPEC DIET@ N/ 34. IV:
35. 02/LPi'i: N 36. SUCT- N 37. NG TUBE: N 38, RESP: N 39. FOLEY: N' 40. STRYKER: N
41. INCUB: N 42. TRACT- N 4,<, IMED: N 44. CAST/LOC: Y / RA 45. TRACH, N 46. MON: N
72. PT BAG TAB 73. PT BAG WT-
47. SUPP INFO: DESERT SHIELD DS FT BLISS TX
49. ?,AX ENRTE STOPS: Y / 9 49. MAX # RONS: Y / 9 50, ALT RESTIMAX HT: N
53. INPATIENT: Y 54. SPEC PROG: VA DRUG ALCOHOL WT NONE X 55. VA CODE:
56. ADMIN/DVERSEAS:
58. VITAL SIGNS(TEMOIPULSE/RESP/BLOOD PRESS)- 099.2 t 80 20 112 72
59. HOB- 60. HCT-. 61. ABS: DATE TAKEN:
62. WBC: 63. SI/VSI: 64. MEDICATIONS: NONE
65. HISTORY-. CAST IS BI VALVED.
66. ATT PHYS, WILKINS 67. FH#. 000 000 0000 68. WARD#/PH#- 000 / 000 000 0000
69. REPORTED BY: A5150 MARTIN 70. PP@#: 000 0000
74. ATTENDANT NAME #I: 75. STATUS. 76. GRADE.
77. AGE- 78. SEX: 70A. WT: 79. RELATIONSHIP TO PATIENT:
90. BAB TYPE: 81. BAG TAG 82. BAB WT:
83, ATTENDANT NAME #2: 64. STATUS: 85. GRADE:
86. AGE,. 87. SEX: 87A. WT: 88. RELATIONSHIP TO PATIENT@
89. BAG TYPE: 90. BAG TAG 91. BAB WT:
92. TRANS ORIS PHONE 4: EXT,
93. TRANS DEST PHONE #: EXT:
94. ETA GRIG MTF(DATEITIME): 000 1 95. EiA DEST MTF(DATE/TIME): 000 1
97@ OTHER COMMENTS:
52. RON LUC-
57. VALIDATED BY/REAS FOR HIGHER PRECEDENCE.
96. AIRCRAFT ITINERARY:
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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