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File: 102896_aug96_decls2_0007.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
05:07 PATIENT FILE 10/22/90
PERSONAL DATA - PRIVACY ACT OF 1974
5 U.S.C. 552 (b)(6)
13. MODE: A
NAME: 18. AUTHORITY 029OA024 2, SSAN: 3. PRECEDENCE: R
4. STAT- All 5. GRADE: WOI 6. ABE: 26Y 7. SEX: M 9. WT: 180 9. READY DATE, 290
10. 160: 11. POR: 12. SPEC CAT:
14. REAS REG: DS 15. DATE LAST VISIT: 16. CLASS: 3A
17. ACCEPT PHYS: JKRO 19. APPT/SURB DATE: NO
20. APPROV AUTH. 21. CANC/INC: 22. VALID: SMF Y7
23. MTF DRIG: A5150 USA DISPENSARY DHAHRAN 24. ICAG GRIG: DEDR
25. MTF DEST: A5040 2ND GEN HOSP LANDSTUHL 26. ICAD DEST: EDAR
27. MED SPEC 1: MMN 28. DIAG 1: 7803- CONVULSIONS
29. MED SPEC 2-@ APY 30. DIAG 2: 7803 CONVULSIONS
31. MED SPEC 3: 32. DIAG 3:
32A. PROCEDURE:
33. SPEC DIET: N/ 34. IV:
3i. 02/LPM. N 36. SUCT: N 37. NG TUBE: N 38. RESP. N 37. FOLEY: N 40. STRYKER: N
45. TRACH. N 46. MON: N
71@ PT BAG TYPE. qB 72. PT BAG TAG 73. PT BAG WT-
47. SUPP INFO@ A CO 159TH AVN REGIMENT, FT. BRAGG, NC
48, MAX ENRTE STOPS,. Y / 9 49. MAX # RDNS-. Y / 9 50. ALT FrtST/MAX HT: N 1
53@ INPATIENT- Y 54. SPEC PROD: VA DRUG ALCOHOL WT NONE X 55. VA CODE:
56@ ADMIN/DVERSEAS.
58. VITAL SIGNS(TEMPIPULSE/RESPIBLOOD PRESS): 111.1 III / 11 / III Ill
53. HBB-. 60. HCT: 61. ADS: I / DATE TAKEN:
62. 6'BC@ 63. SIIVSI: 64. MEDICATIONS- DILANTIN 30OKS AT NIGHT
65, HISTORY: WITNESS TONIC CHRONIC SEIZURE 14 OCT 90, NEW (ABET CT LAD WITHIN NO
RMAL LIMITS. REQ NEURO CONSULT/EEG.
66. ATT FHYS; CUROWSKY 67. OH#: 000 000 0000 68. WARD#/FH#. 000 / 000 000 0000
69. REPORTED BY: GUIDO 70. PH#: 000 0000
74. ATTENDANT NAME #I: 75. STATUS- 76. GRADE:
77. AGE: 78. SEX: 7P@A. WT: 79. RELATIONSHIP TO PATIENT:
80. BAG TYPE: 81. BAG TAG 82, BAG WT-
&3. ATTENDANT NAME #2. 84. STATUS: 85. GRADE:
86. ABE: 87. SEX-. 87A. WT: 68. RELATIONSHIP TO PATIENT:
89. BAG TYPE: 90. BAG TAG 91. BAB WT-
92. TRANS CRIG PHONE EXT:
XT:
94, ETA ORIG MTF(DATE/TIME)-. 000 1 95. ETA DEST i4TF(DATE/TIME): 000
97. OTHER COMMENTS:
51. MSN 52. RON LOC;
57. VALIDATED BYIREAS FOR HIBHER 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