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File: 102896_aug96_decls3_0005.txt
Subject: PATIENT FILES 21 DEC 90
Box ID: BX000482
Unit: ARCENT
Parent Organization: CENTCOM
Folder Title: MEDSTAT - SITREPS DEC 90 2 OF 6
Folder SEQ #: 6
Document Number: 5
PAT-E@
iT T:Tl P '0/2' 90
PERSCINAI DATA PRIVACY AC-, OF 1974
5 U.S.C. 552 (b)(6)
13. A
i@ NAME: 16. AUTHORITY #: O'@5'AOB' SBA'ci': 3. PRECEDENCE: R
4@ STI@@T: All 5. GRADE: E04 6. AGE: 25Y 7. SEX: il 8. WT: 165 9. READY DATE: 351
10. isol 11. POP@ 12. SPEC CAT:
14. REAS RE'@@. DS i5. DATE LAST VISII: 16@ CLASS@ 3A
17. ACCEPT PHYS: JMRO 19. APPT/SURB DATE- ND
20. APPROV AUT4: 21. CANC/INC: 22. VALID: imo Y9
23. MTF ORIG- A5'50 USA DISPENSARY DHAHRAN 24, ICAO DRIG: OEDR
25@ MTF DEST: F5070 USAFR@MC WIESBADEN GE 26. ICAO DEST; EDAF
27. NED SPEC 1: 900 28. DIAG 1: 83100 CLOSED DISLOCATION OF SHOULD'AR, UNSPECIFIED SITE
29. NED SPEC 2: 30, DIAG 2-
31. Mc@D SPEC 3: 32. DIAS 3:
Z2A, PROCEDURE:
33. SPEC Dl'cT: N/ 34. IV:
35. 02/LPM: N 36. SUCT: N 7@7. NG TUDEZ N 38. RESP: N 39. FOLEY: N 40. STRYKER: N'
. IMEDT N 44. CASTILOC: N 45. TRACH: N 46. VION@ N
71. PT BAD IYPE. ND 72@ PT BAG TAB 73. PT BAG WT:
47. SUPP INFO: 249 PNGR KASELL, GE 85'Fd EVAC HO
SP
48. MAX ENRTE STOPS: Y 9 49. MAX # RONS: Y 9 50. ALT REST/MAX HI: N
53. INPATIENT., Y 54. SPEC PROST VA DRUG ALCOHOL ',4T NONE X 55. VA CODE:
56. ADMIN/OVE.RSEAS.
58. VITAL SIGNS(TEMP/PULSE/RESP/BLOOD PRESS): 097.0 66 16 120 80
59. HBB: 60. HCT: 61, ABG: DAIE TAKEN:
62. NBC: 63, SI/VSI: 64. MEDICATIONST NONE
65. HISTORY; INJURY 6 MONTHS AGO RECURRENT SHOULDER DISLOCATION WITH MINIMUM
ACTIVITY. PHYSICIAN RECOMMENDS OUT OF THEATER.
66, ATT PP@YS: 6@.NNP.RG 67. PH#- 000 000 0000 66. WARD#/PH#t 000 / 000 000 0000
69. REPORTED BY@ GUIDO 70. PH#: 000 0000
74. ATTENDANT NAME 1: 75. STATUS: 76. GRADE:
77. AGE@ 78. SEXT 78A. 6'T: 79. RELATIONSHIP TO PATIENT:
80. BAG TYPE: 81. BAG TAG 82. BAG WI:
83. ATTENIDANT NAME #2: 84. STATUSI 85. GRADE:
66@ AGE, 87. SEX: 87A. WT: 88. RELATIONSHIP TO PATIENT:
89. BAG TYPE; 90. BAG TAG 91. BAS WT:
EXT:
9.3. TRANS DEST PHONE #t EXT:
94@ ETA CRIS i4TF(DATE/lItqc@)@ 000 1 95. ETA DEST MTF(DATE/'tIME): 000
97. OTHER COMMENTS:
51, @ISN #: 0000/352 52. RON LOC-
57. VALIDATED BY/REAS FOR HIGHER PRECEDENCE:
96. AIRCRAFT ITINERARY; I
5 USC 552 (b)(6)
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Document 26 f:/Week-32/BX000482/MEDSTAT - SITREPS DEC 90 2 OF 6/patient files 21 dec 90:10019616503519
Control Fields 17
File Room = aug96_declassified
File Cabinet = Week-32
Box ID = BX000482
Unit = ARCENT
Parent Organization = CENTCOM
Folder Title = MEDSTAT - SITREPS DEC 90 2 OF 6
Folder Seq # = 6
Subject = PATIENT FILES 21 DEC 90
Document Seq # = 5
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