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File: 102896_aug96_decls2_0009.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
05-04 PATIENT FILE 10/??/90
PERSONAL DATA - PRIVACY ACT OF 1974
5 U.S.C. 552 (b)(6) 13. TIODE: A
1. NAVE@ 18. AUTHGRITY 027OA003 2. SSRN- 3. PRECEDENCE: R
4. STft-i: All 5. GRADE: E04 6. ACE: 21Y 7. SEX: M B. WT: 165 9. READY DATE,. 290
10. ISO: 11. FOR- 12. SPEC CAT:
14. REAS REC: DS 15. DATE LAST VISIT: 16. CLASS: 2A
17, ACCEPT PHYS: 19. APPT/SURG DATE- KID
20. APPROV AUTH; 21. CANC/INC-. 22. VALID: SMF Y5
23. MTF DRIS: A5150 USA DISPENSARY DHAHRAN 24. ICAD GRIG: DEDR
25. MTF DEST: F5070 USAFRMC WIESBADEN BE 26. ICAD DEST: EDAF
27. MED SPEC 1: SOD 28. DIAG 1: 9597 OTHER AND UNSPECIFIED INJURY TO KNEE, LEG, ANKLE, AND FOOT
29. NED SPEC 2: 30. DIAS 2:
31. [iED SPEC 3: 32. DIAG 3:
32A@ PROCEDURE:
33. SPEC DIET: NI 34. IV-
35. 02/LPM: N 36. SUCT: N 37. NG TUBE: N 38. RESP: N 39. FOLEY. N 40. STRYKER@ N
CAST/LOC: N 1 45. TRACH-. N 46. MON: N
71. PT BAG TYPE. NB 72, PT BAB TAG 73. PT BAB WT-.
47. SUOP INFO. DESERT SHIELD DS FT. STOREY VA
48. MAX ENRTE STOPS: Y 1 9 49, MAX # RONS: Y / 9 50. ALT REST/MAX HT-. N
53. INPATIENT: Y 54. SPEC PROS: VA DRUG ALCOHOL WT NONE X 55. VA CODE:
56. ADIMINIOVERSEAS:
58. VITAL SIGNS(TEMP/PULGE/RESPIDLOOD PRESS): 096.8 50 16 / 108 70
59. HOB: 60. HCT: 61. ADG: I DATE TAKEN.-
62. WBC: 63. SI/VSI-. 64. MEDICATIONS. NONE
65. HISTORY: 2YR HISTORY OF OSTEOCONDYTIS LEFT KNEE, ELEVATED EPISODE IN FIELD
ENVIRONMENT. PT CAN'T WALK WELL.
66. ATT PHYS- THORPE 67. PH#-. 000 000 0000 68. WARD#/PH#z 000 / 000 000 0000
69. REPORTED BY: A5150 MARTIN 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. BAB TAG 82. BAG WT:
83. RITENDANT NAME #2: B4. STATUS: 85. GRADE:
86. ACE: 87. SEX: 87A. WT: 88. RELATIONSHIP TO PATIENT;
89. BAB TYPE: 90, BAG TAB 91. BAG WT:
HONE EXT:
93. TRANS DEST PHONE EXT.
94. ETA GRIG MTF(DATE/TIME): 000 1 95. ETA DEST MTF(DATE/TIME). 000
97. OTHER COVIMENTS-
Si@ MSN #: 52. RON LOC:
57. VALIDATED BYIREAS FOR HIBHER PRECEDENCE-
96. AIRCRAFT ITINERARY: I 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