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File: 102896_aug96_decls2_0010.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 10/22/90
PERSONAL DATA - PRIVACY ACT OF 1974
5 U.S.C. 552 (b)(6)
13. MODE: A
1. NAME; 18. AUTHORITY 029OA002 2. SSAN: 3. PRECEDENCE-. R
4. STAT: All 5. GRADE: EOI 6. AGE: 21Y 7. SEX: i@ 8. WT: 160 7. 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. APPTISURG DATE-, Ng
20. APPROV AUTH-. 21. CANC/INC- 22. VALID: STIF Y5
23. KTF GRIG: A5150 USA DISPENSARY DHAHRAN 24. ICAO BRIG: GEDR
25. MTF DEST; A5040 2,ND GEN F@OSP LANDSTUHL 26. ICAO DESTI EDAR
27. MED SPEC I- SOOL 28. DIAG 1: 8472 LUMBAR SPRAIN
VIED SPEC 2- 30. DIAG 2-
31. NED SPEC 3: 32. DIAG 3:
32A. PROCEDURE:
33. SPEC DIET: N/ 34. IV:
35. 02/LPM: N 36. SUCT: N 37. NG TUBE: N 39. RESP: N 39. FOLEY: N 40. STRYKER-, N
T/LGC: N 45. TRACH-. N 46. MON: N
71. PT BAB TYPE: NIB 72. PT BAG TAG 73. PT BAB WT:
47, SUPP INFO: DESERT SHIELD DS 1,7 CAMPBELL kY
48. MAX ENRTE STOPS: Y / 9 49. MAX # RONS: Y / 9 50. ALT RESTIMAX HT. N
53. INPATIENT: Y 54. SPEC PROB: VA DRUG ALCOHOL WT NONE X 55. VA CODE:
56, ADMIN/DVERSEAS;
58. VITAL SIGNS(TEMP/PULSE/RESP/BLOOD PRESS): 097.2 64 / 20 / 122 92
59. HGB: 60. HCT: 61. ABB: / DATE TAKEN:
62. NBC: 63, SI/VSI- 64. MEDICATIONS: VALUM 5MG PO DID, TYLENOL #3 1-2 IA
BS 04HRS PRN.
65. HISTORY: PT FELL OF VEHICLE 06 OCT 90 AND HURT BACK,.
66, ATT PHYS: STEVENS 67. PH#- 000 000 0000 68. WARD#/PH#- 000 / 000 000 0000
69. REPORTED BY: A5150 MARTIN 70. PH#: 000 0000
74. ATTENDANT NAVE #1. 75. STATUS-. 76. GRADE-
77. AGE: 78. SEX- 78A. WT: 79. RELATIONSHIP TO PATIENT:
80. BAB TYPE: 81. BAG TAG 82. BAG WT:
83. ATTENDANT NAME #2: 84. STATUS: 85. GRADE:
86. AGE: 87. SEX: 87A. WT: 68, RELATIONSHIP TO PATIENT:
89. BAG TYPE, 90. BAG TAG 91. BAG WT:
92. TRANS DRIG PHONE EXT-.
ST PHONE EXT:
94. ETA CRIG MTF(DATE/TIME)- 000 1 95. ETA DEST MTF(DATE/TIME): 000
97. OTHER COMMENTS:
51. MSN #@ 52. RON LOG:
57, VALIDATED BYIREAS FOR HIGHER PRECEDENCET
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