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File: 102896_aug96_decls4_0009.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
5;. @X@ #: 0000/301 5'-7@ PON
57. VA IT DATED BY/REAS FOR HIGHER PRECEDENCE;
96 . AT RCRAFT ITINERARY@ I
04:00:06 PAT TEN1 FILE io/7,0190
I
PERSONAL DATA - PRIVACY ACT OF 1974
5 U.S.C. 552 (b)(6) 13@ MODE: A
NAN-@@ 19. AUTHORITY 4: 0302AO45 O.. SSAN'T 3. PRECEDENCE: R
4. STAT: All 5. roRAD-@: C-04 6. AGE; 25Y 7. SEX: S. WT. 150 9. READY DATF-I 302
10. I 0: li@ POR@ 12. SPEC CAF@ I
It@. R'CAS RE@ 'us 15, DAT I ST VISITI 16. CLASS: 3A
,E LA
'7. Ar
i -CEF -HYS@ J?L@RD 19. APPTISURQ' DATE: NO
20. APPRU-V .4UTP,: 21, CP@N'@/IN-U! 22. VALID-, DM Yi
2@-,. IITF r,'Dlg: A5i5O USA DISPENSARY DHAHRAN 24. ICAO DRIG: OEDD
2o'. F,,iF Dz'ST@ F5070 LISAFRIMC WIESBADEN GE 26 TCA,13 DEST: E@.AF
OTHER AND UNSPECIFIED INJURY TO KNEE, LEC, ANKLE, AND FOOT
29. MED SPEC 2: ",O. DIAS 2:
3i@ @1,ED SPEC 3@ 7,2. DIAS 3:
3'-?A. PROCEDURE!
33. SP-cc DIET: Ni 34. TV@
'o7 B
02ILPVi@ 36, SUCT: .NG I" Et N 38. RESP: N 39. FOLEY: N' 40. STRYKER% N
41. Ii\[C'u'B: i@' 42. T@RAC-: N 43@ IRIED: .4 44, CASI-/LCC- @N 45, TRA@.H@ 46. riON:
I
71. PT BAB TYPE.- NIB 72. PT BAG -@AS 7--,. PT BAB WT:
47. SIJPP INFO: @@ '1502ND FT, CAMPBELL, KY REPORTED BY
48. VAX ENRTE STOPS: Y / 9 49. IAX # RONS: Y 9 50. ALT RIcST/ri'X HT: N
53= i@4PATI'cNT@ Y 54. SPEC PRDGZ VA @ 6 ALCOHOL WT NONT- X Y@. VA CODE:
56@ ADMTN/OVcRSEAS:
58, VITAL S18NE(Tc,MP/ U"sc,/RESP/BLOOD PRc,SS): 098.6 72 20 1 118 7B
,9@ F.SB; 60. P.P@T: 61. ADGT I I DATE TAKEN:
62. i4BC@ 63. SI/VSI; 64. @MEDICATIONIS,, RDTRIN BOOMS TID
65@ t,4.ISTGRY@ 25YO @'M W/Hv OF ANKLE !Nj IN' 1981 AND REPEA@RT IN RECENT YEAR. PT N
ON HAS VARUS DEFORMITY OF L. ANKLE, WHICH REQUIRES TX AND POSSIBLE MEB PROCEE
DNI'SE.
66. ATT PFYS: MAR)IN L7. Ph@: 0,00 000 00@00 68, WADD#/PH#; 000 / 000 000 0000
70, PH#: 000 0000
74, ATTENDANT NAME 75. STATUS: 76@ GRADE:
77. ABE: 78. SEX: 78A. WT: 79. RELATIONSHIP TO PATIENT:
80. BAB TYPE: 81. BAG TAG 82. BAB t4T:
83@ ATTENDANT NAME 84. SIATUS: B@@. @@RADE:
86. AGE: 87. SEX: 87A. WT: 88. RELATIONSHIP TO PATIENT:
89, BAD 1-YPE@ 90. BAD [AS @i 91. BAG Iq-1:
9@4. TRANS OR TG @o'-Il@IE EXT:
9-z@ TRANS DEST Pu'@INP- 'I: Ix'@
94@ ETA ORIG ikiTF(DAI@@/Ti@ME): 000 95. ETA DEST NI-@F(DATEITI.IE): 000 1
97@ OTHER COMMENTS:
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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