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File: 102896_aug96_decls4_0005.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: 11
04 z @0:4-@ PATIENT FILE 10130/90
PERSONAL nAA - PRIVACY ACT rjF 1974
5 U.S.C. 552 (b)(6)
17
MODE! A
18. AUTHORITY 03OIA031 2. SSAN; PRE@,EDEN@'@'E: R
4. STATI A'! 5@ CRADE: E04 6. AGE: 22Y 7. SEX: il B. W": 113 9. READY D@@TET
10@ !60,, 11. POD: 12. SPEC CAT: 1
'4@ Rc 5 REG. A
i @A , DS DATE LAST VISIT@ 16. 'CLASS: 2A
17. ACCEPT P@4Y@ 19. A@p,/SUD DATE: NO
20. APPROV A)JTH@ 21. '@ANC/Iix'C: 22. VALID: JRi- Y2
23@ Fi-iF BRIS: A5150 USA DISPENSARY 24@ ICAO CRIG: OEDR
25. Vii-F DEST@ F5070 U-SAFR,.IC 141EBRADEN GE 26. ICAU DclsTi r'DAF
ITIS,Th'RO,@'iBOP,@"LEBITIS, OTHER DEEP VESSELS OP7 LEG
ED
29. @'IED SPEC 30. DIAG
tItED SPEC 3@@ 32. DIAS 3;
32A. PROCEDURE;
33@ SPEC DIET: I/ @4. IV; 1
35@ 02/LP,'i: N 36. SUCT: N 37. NG TUBE: N 38. REB-P: k@ 19. FOLEY: N 40. STRYKER: @l
41, INCUB2 \1 42. T 8 T; N 43. I@t' N 44. @IASTILO': 45. TRACH: N 46. iNOiN': @l
. R@.@@ u u
7i. FT BAG TYPE: NB 72. PT BAG TAB 77.. PT GAS t4T:
47@ SUPP Tk'FO: FT BRASS NC 5
4@ MAX ENRTC, STOPS: Y 9 49, MAX Y 9 50. ALT RES!IMAX @'T: iN
53. liNPqTIc@.INT@. Y 54. SPEC DROB: VA DRUB ALCOHOL WT NO,\-'a X 55. VA CODE:
cR
6. ADV.11'IQV' ScASt
@o
VITAL SIBi\S(-',EriPIPULSE/RESP'Bl.nDD PRESS); 098.8 78 16 I i2c) 60
59. u.B: 60. u@Tz 61. AB'u@@ DATE TAKEN:
62. WqCi 63. SI/VSI@ 64. MEDTCATIONS@ NONE
65. HISTORY-. PT HAS 3 DAY HX 'OF L LEG S'-.@@El@LINB & PAIN,
66@ ATT PLI.YS: NONE 67. PH#i 000 000 0000 68@ 'AARD@/@DH#i 000 I 000 000 000@)
REPORTED BYt MSG-,, MARTIN 70@ PP,#: 000 0000
74. AITENDANT NAME 4': 75. STATUS: 76, zrRADEi
77. AGE: 78. SEXT 78A. WT: 79, RELATIONSHIP TO PATIENT:
80, SAO TYPEZ 91. BAB TAG II.: 82. BAG WT:
Sl,. ATTENDANT NAME #2: 34. STATUS: S5@ GRADE@
86. AGE2 87. SEX: 87@4. WTt 88. RELATIONSHIP TO PATIENT@
89. BAB TYPE: 90. DAB TAG 91. BAG W':
92. TRANS CRIG PHONE #g EXT;
93, TRANS DEST PHONE 1: EXT:
9P,T@ ETA DRIS @NTF(DATE/Ti@@-)t 000 1 95. ETA DEST MIF(DA T /Tiil')@ 000
.E a
97. OTHER COMMENTS:
51. MBN @: 'VO00/301 52. RON '@O@
57, VALIDATED BY/REAS FOR HT&,-- P @ Dal@ICE:
I @ P, , R@CE
96. ATRR Ar@T T Tli%TERA@RY:
@ OR I
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Document 31 f:/Week-32/BX000482/MEDSTAT - SITREPS OCT 90 3 OF 4/patient file:10019616503620
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 # = 11
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