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File: 102896_aug96_decls4_0007.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
03;59-@34 PATIENT 10/30/90
PERSONAL DATA - PRIVACY ACT OF 1974
5 U.S.C. 552 (b)(6) 13, @,ODE: A
1. NAME: 18. AUTHORITY #: 0302AOOI 2. SBA@I; 3. PRECEDC@NICE: R
4. STAT@ All 5. GRADE@ E06 6. AS;-:@ 38Y 7. SEX: V@ B. WT: 2@110 7. READY DATE: 301
10. !SI3: ilz POR: 12. SPEC P@4 I
14. iEAS R@,G@ DS 15, DATE LAST VISIT: 16@ CLASS: 3A
17@ ACCCPL PHYS; 19. APPT/SURG DATE@. MD
20@ APPROV AL@ITH; 21. CANC/li@'C: 22. VAL-ID: JRL YA@
2'o. V@@TF ORIG: A5150 USA DISPENSARY D.4.Ai@RA,@4' 24. ICAO ORIGI OEDR
25. il)TF Dc-'ST-. 45030 FRANKFURT ARMY REG I@IED -46. I'@AG DEST: EDAF
27. i@c,D SPEC I- MMC 28. DIAS l@ 41,-,@9 OTHER AND IJNSPECTPIED ANSINIA PEC' RIS
29. im-tv SPEC 2; 30. DIAS 2:
31. @@',ED SPEC 3: @2. DIAS 3;
@-,A. PROCEDURE:
34. TV:
5. 02/LPM,: %I S6. Sli@@T: %' 37@ NC TUBE: N 39. RESP: N 39, FOLEY: N 40. STRYKERI N
41. liN@PLIB: t@ 42. TRACI-. N 47@. IriED-@ N 44. CAST/LDC: N f 45. TRACH: N 46. j@Oi%@ N
71@ PT BAB TYPE: NB 72@ Pi BP.6 TAG 73. PT BAG tk'T:
47, SUPP INFO: FT BEiNiNli@10 SA 5 r@AS.4
48. MAX ENRTE SIOPS: Y / 9 49. MAX 41 R'Ll@@IS: Y/ 9 50. ALT RE97ifriAX HT@ N
37). !,.NPA@ilENT: Y 5t@. SPEC PROG: VA ALCOHOL WT N@ONIE X 55. VA CODE:
56@ ADi4,INIGVPPc,EA.S@
59. VITAL SISNS(TFmP/PUIISE/RESPIBLn@OD PRc,BS)t 097.4 / 62 1 16 / 110 60
-9. @I.GB 61. A@,ro: I DATE T6.KENt
60. PDT:
6@@@ WBP@L 63. SI/VS!: 64. MEDICATIONS: NITROPASTE I" Q6H, @@,IITROBUC'cRIN@,
1/200 SL X 3 PR%!
65. HIS' RY: PR-@ ENTED W/@\';: ONSET CHEST PAIN. H.X WAS IN LINE WITH CORONARY ART
I 10 @s
c -6 ED
,RY DISEASE ADMITTED AND CARDIAC EtN'ZYFi@ WERE HIGH AT NIORIA.AL RANGE. PT KIE; S
FURTHER WORKUP FOR CAD TO !NICLU@DE TREADMILL STRESS TEST.
@DH#: 000 I 000 000 0000
69. REPORTED BYi MSST MARTIN 70. PF,#@ 000 0000
74. ATTENDANT NAME 1: 75, STATUS: 76, GRADE@
77. AGE@ 79. SPX@ 78A. @4T: 79. RELATIONSHIP TO PATIENT:
80@ @4@ lyp@ 61. BPOP TAG @t-. 82. BAB W.
83. ATTENDANT NA@I@E #2: 94, STATUS: 85. GRADE:
86. AGc@@ 97. SEX: 87A. 66. RELATIONSHIP TO PATIENT:
89. BAG TYPE: 90. BA' TAP. 91. BAG WT:
92. TRANS ORTR NIONIZ EXT:
9 . TRANS DES I PHONE EXT:
94. c A ORIG iMT (DA.Tc/TIME): 000 95. A DEST imT-(DATE/-,"I 000
I F
97. OT ER COr.-M,' TS:
PI --N
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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