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File: 102896_aug96_decls4_0006.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, 1 !:-@O PATIENT FILE 10/30/90
PERSONAL DATA - PRIVACY ACT OF 1974
5 U.S.C. 552 (b)(6)
'L3. ri'uDEz A
1. NAME- 18. AUTHORITY 2. SSAN: 3. PREC-tDENCEi R
4. STAT: A'l 5. G@'ADEZ EO 6. AG--: 'i9Y 7. SC@X-@ 1". 3, 1.4T@ 159 9. READY DATE: 300
10@ ISO- li, PORT 12. SPEC CAT:
14. REAS RE[z: DS 15. DATE LAST VISIT., 16, CLASST 3A
i7@ ACCEPT PhY@,: JVRul 19@ APPT/SURS DAsEt NO
20. AFPROV AUTP,: 21. CANCIINC@ 22. VALID:
23. @,TF ORIC: A@@150 USA DISPENSARY DHAHRAN 24, IPIAO CRIG: 07tDR
25. @-,iTF DEST: F5070 USAFRRC WI' BADEN SE 26. ICAO DEST@ EDAF
27@ @-lc,D SPEC 1- SSE 28. DIAS l@ 84,08 SPRAIN OF OTHER SPECIFIED SITES OF SHOULDER AND UPPER ARM
29. KD SPEC 2: 30. @,'LAG 2:
ra'c
riEL' S' 3i 32@ DIAS 3-
32A. PRG'UEDU@,RE;
3--,@ SPEC FIlc@T: NI 34. IVi N/
JCT: N 37@ t%lg TUBE: N @ls. RESP: N 39. FOLEY: bO. STRYKERT Ni
4'@ TNCJB: N42. iRA'uT: 43@ T@'iED: N b,4. 'UAST/LOCt Y LA, 45. TRACHT N 46. i@tOiN: N
71@ PT BAG TYFE: NB 72. PT BAB TAG 73. Fi BAG WT:
47. SUPP !NIFO@ C CC, 2/5 CAV -T uOi'-'D, TX REPORTED BY
i
5-" Ei4,A6H
49. MAX EN.IRTE STOPS% Y1 9 49@ MAX # OONS@ Y 9 50. ALT R---ET/@',AX 4T@ N
57@. l@%-PA7" T, Y SP' PROO: VA DRUB ALCOHOL t4T NONE X 55@ VA COD---:
4 EC
56. AD.Mii\I/DVERSP-AS:
@3, VITAL SIG,%'S(TEriPIPULSc@/RESP/BL,3'UD PRESS): 098.0 / 060 16 120 f SC'
T
/ DATE TA!LCN:
19, FG@ 60. Hri i 61. AB@ I
6@L. 63, SI/VSI- 64. MEDICATIONS 'UODINE 60 r,,B PO Q 3 P@RS
6-z@ P.!SiORY; INJURIED LEFT ARM RESULTING IN PAPTIA'@ REPLITURE OF LEFT BICEPT, @\-E
- OC7
ED c@var@ FOR PROLONGED R'UGVERY@ FOOTBALL IN'URY ON 2' 90. CAS@' ON 26 CC
T
66@ ATT P@'YS: MAJ WOKI@@4 67. PP,4@ 000 000 0000 68. '@IARD*lr'H#z 000 000 OAIO 0000
69. REPORTED BY: GUIDO 70, PP.#- 000 0000
75@ STATUS: 76. GRADE:
77@ P@Sc@: 78@ SEX: 76A. lilt@ 79. RELA71ONSHIP TO FAIIE@NI:
So. BAB TYPE: 81. BAG TAG 4: 82. BAG 'w'T:
1
03. ATtc,INDAN'T NAME @@2: 84. STATUS: 85. GRAD"-.
86. ACE: 87. SEX: 87A. WT- 88. RELATIONSHIP iO PATIENT-
69. BAB IYPE: 90. BAG TAB 91. GAS WTt
92. TRANS 2RI3 PHONE EXT:
9'-,. TRANS DEST PHONE '.a,: EXT:
?4. ET ORlr MTF(DAT@/Tl@.E): 95. ETA DEST -YiTF(DATE/T-,'IE):
,A c
97. 0-@, HER CONV.ENTS:
51@ VIS-N #t 00001'300 52, RON Ln.Ci
a @N@E
7. VALIDATL BY/REAS FOR HIGHER PREP@D-- 1
'?6. AIRCRAFT ITINERARY I 11
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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