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File: 102896_aug96_decls2_0008.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
05:03 PATIENT FI[F 10/22190
PERSONAL DATA - PRIVACY ACT OF 1974
5 U.S.C. 552 (b)(6) 13. MODE. A
1. NAME: 18. AUTHORITY 029OA004 2. SSAN- 3. PRECEDENCE: R
4. STAT: All 5. GRADE-. E04 6. AGE: 28Y 7. SEX; M B. WT: 180 9. READY DATE: 290
10. ISO- II. POR: 12@ SPEC CAT:
14. REAS REG: DS 15. DATE LAST VISIT: 16. CLASS: 3A
17. ACCEPT PHYS: 19. APPTISURG DATE: NIB
20. APPROV AUTH: 21. CANC/INC: 22. VALID: SMF Y5
23. MTF BRIG: P.5150 USA DISPENSARY DHAHRAN 24. ICAD BRIG. DEDR
25. MTF DEST-. A3040 2ND GEN HOSP LANDSTUHL 26. ICAG DEST: EDAR
27. MED SPEC 1: MC 28. DIAG 1: 4270 PAROXYSMAL SUPRAVENTRICULAR TACHYCP.RDIA
29. NED SPEC 2. 30. DIAG 2i
31. NED SPEC 3- 32. DIAG 3:
32A. PROCEDURE:
33, SPEC DIET@ Y/N 34. IV-
35. 02/LPM: N 36, SUCT: N 37. NG TUBE: N 38. RES?: N 39. FOLEY: N 40, STRYKER- N
41. INCUB: N 42. TRACT: N 43. IIMED: N 44. CAST/LOG: N 45. TRACH. N 46. MON- N
73. PT BAB WT@
47. SUPP INFO. DESERT SHIELD DS CHICAGO IL
48. MAX ENIRTE STOPS: Y / 9 49. MAX # RONS, Y / 9 50. ALT REST/MAX HT: N 1
53. INPATIENT: Y 54. SPEC PROG. VA DRUG ALCOHOL WT NONE X 55. VA CODE:
56. ADiIIN/GVERSEAS:
58. VITAL SIGNS(TEMP/PULSE/RESP/BLOOD PRESS): 098.2 80 16 110 76
59. HOB: 60. HCT: 61. ABB: DATE TAKEN:
62. WBC: 63. SI/VSI: 64. MEDICATIONS: NONE
65. HlgioRY: PALPITATION AND CHEST PAIN.
66. ATT PHYS: FELLOWS 67. PH#: 000 000 0000 68. WARD#IPH#. 000 / 000 000 0000
69. REPORTED BY@ A.5150 MARTIN 70@ PH#. 000 0000
74. ATTENDANT NAME #I- 75. STATUS: 76. GRADE:
77. AGE: 78. SEX: 79A. WT- 79, RELATIONSHIP TO PATIENT-.
80. BAG TYPE-. 81. BAG TAG 82. BAG WT.
83. ATTENDANT NAME #2: 94. STATUS, 85. GRADE:
96@ AGE: 87. SEX- 87A. WT: 88, RELATIONSHIP TO PATIENT:
09. BAG TYPE: 90. BAG TAB 91. BAG WT:
92. TRANS BRIG PHONE EXT,
93@ TRANS DEST PHONE EXT:
94. ETA BRIG MTF(DATE/TIME): O@@o 95. ETA DEST iMTF(DATEITIME): 000 1
97. OTHER COMMENTS:
52. RON LOC:
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