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File: 102896_aug96_decls2_0011.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
05:35 PATIENT FILE 10122/90
PERSONAL DATA - PRIVACY ACT OF 1974
5 U.S.C. 552 (b)(6)
13. MODE: A
1. NAME: 18. AUTHORITY 028BA029 2. SSANI: @ 3. PRECEDENCE: R
4. STAT. All 5. GRADE: E04 6. AGE: 24Y 7. SEX: F S. WT: 130 9. READY DATE: 28B
10. ISO-. I 1. POR: 12. SPEC CAT:
14. REAS REG@ DS 15. DATE LAST VISIT: 16. CLASS. 3A
17. ACCEPT PHYS- JMRO 19. APPT/SURB DATE: NO
20. APPROV AM.: 21, CANC/INC: 22. VALID: JRL Y6
23. MTF ORIG: A5150 USA DISPENSARY DHAHRAN 24. ICAD CRIS: OUR
25. MTF DEST., A5040 2ND GEN HOSP LANDSTUHL 26. ICAD DEST: EDAR
27. NED SPEC 1. VIMN 28. DIAG 1: 3454 PARTIAL EPILEPSY, WITH IMPAIRMENT OF CONSCIOUSNESS
29. MED SPEC 2: 30. DIAG 2-
31. MPD SPEC 3: 32. DIAG 3:
32A. PROCEDURE:
33. SPEC DIET: Nt 34. IV:
35. 02/LPM: N 36. SUCT; N 37. NO TUBE: N 38. RESP- N 39. FOLEY: N 40. STRYKER- N
INCUB.- N 42. TRACT: N 43. IMED: N 44. CAST/LGC: N 45. TRACH: N 46. MON: N
71, F't BAG TYPE.- NB 72. PT BAG TAG 73. PT BAB WT:
47. SUPP INFO: DESERT SHEILD DS: FT CAMPBELL, KY
48. MAX ENRTE STOPS: Y / 9 49. MAX # RONS: Y / 9 50. ALT REST/MAX HT.- N
53, INPATIENT: Y 54. SPEC PROG: VA DRUG ALCOHOL WT NONE X 55. VA CODE.
56. ADMIN/GVERSEAS:
59. VITAL SIGNS(TEMP/PULSE/RESP/BLOOD PRESS)- 097.9 1 72 16 104 70
59. HGB: 60. HCT: 61, ADS-. DATE TAKEN.
62. 14BC.- 63. SI/VSI: 64. MEDICATIONS-. N
65@ HISTORY. R/O TL EPILISPY.
66, ATT PHYS: NORTE 67. PH#- 000 000 0000 66. WARD#/PH#: 000 I 000 000 0000
69. REPORTED BY- AS150MARCHANTEK 70. PH#: 000 0000
74. ATTENDANT NMME #I: 75. STATUS: 76. GRADE:
77. AGE- 78. SEX- 78A. 6'T- 79. RELATIONSHIP TO PATIENT-
80. BAG TYPE: 81. BAG TAG 82. BAG WT.
83. ATTENDANT NAME #2: 04. STATUS: 85. GRADE:
86. AGE: 67. SEX: 67A. WT: 88. RELATIONSHIP TO PATIENT:
89. BAB TYPE- 90. BAG TAB 91. BAG WT:
EXT:
93. TRANS DEST PHONE EXT:
94, ETA DRIG MTF(DATE/TIME): 000 95. ETA DEST MTF(DATE/TIME): 000
97. OTHER COMMENTS:
51. MSN 52. RON LGC:
57. VALIDATED BY/REAS FOR HIGHER PRECEDENCE:
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