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File: 102896_aug96_decls4_0010.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
@@l = MEN #: 0000/301, 32. RON LOcl:
57. VALIDATED BY/REAS FOR HIGHER PRECEDENCE:
96. AIRCRAFT ITL\IERAIY:
04:00:24 PAilEi@',T FILE 10130/90
PERSONAL DATA - @RIVA Y ACT 0- 1974
@c r
5 U.S.C. 552 (b)(6) 13. MODE@ A.
l@ NA@c@@ 18. AUTHORITY 4: 0302AO44 2. SSA@N: 3. PRECEDENCE: R
4. STAT: All 5. GRADET c@O'L 6. ABE: '-,OY 7. SEX: M S. ',@@Tg 170 9. READY DATE: 02
10. ISO: !I. POR: 12. SPEC CATT
14. R'@AS Rc,G! DE 15. DATE '-P.St VISIT: 16. 'CLASS: 3A
17@ ACCEPT PHYS: j@'@RO 19. APPT/SURB DATE% NO
20, APRRDV AUTH@ '41. CANCITN@C; 22. VALID: I BM Yi
23. VjTl-- DRIG: 45150 USA DISPENSARY DHAHRAN 24. !CA@O OR16i OC@DR
23. M.TF DESI: F5070 USAF@@RC WIESBADEN GE 26, ICAD DEST@ EDAF
C It 500 28@ DiAfa It 81 00 CLOSED FRACTURE OF UPPER END OF FOR-tAR@'@, UNSPECIFIED
29= VIED SPEC 2: 30@ DIAr3 I.:
31, @MED SPEC -1,; Z,2. DIAG 3:
3' A. PROCEDURE:
33. SPEC DIET: i'i/ 74@ iv@ 1
35. 02/LP@t: %'- /36. SUCT- N' 37. Ng TUBE: iN 32. RESP: N 39. FOLEYT N' 40. 57iRYKER,. \1
41. INEU@@: ti 42. TRACT; N 43. IVIED: N 44. CPST/LOC: N' 45. TRACH- N 46, iN
7i. PT DA,6 TYPE- i%'B 72. PT BAD TAG 77@. PT BAB '4T:
47@ SUPP !NFO@ B CO. 726iH ;-:NSR@ FT. BRAGS, MC R4EPORTED BY
28 CS4
43. MAX STOPS: Y / 9 49@ MAX @'. RO,\'S- Y / 9 50. ALT REST/iMAX HT: N' f
@3@ INPATIENT: Y @14. SPEC PR'IG@ VA. Do S A'@C0401 6,T NON,@ x 53. VA CODE:
Q6, AD'@ji.\'ICV'cRSEAS-.
59. VITAL SCOS(iEmp/PUIISE/,REEP/BLDD@. PRESS); 098.4 70118 126 78
@9. HSB@
60. HUtz 61. ADG: I DATL TAKEN:
6". @iBC: 63@ SI/Vgli 64. rjc.DIC.ATIDNS: VOTRIN 800rGg STID
6@'. 20YO '@,X OF SU8LUXATION OF R. S@'DU-DER XBI.-'@0S. DljRINIC IHIS PERIOD HE
HAS HAD 6 INJC,CTICNS @41-14OUT RESULT . REnU@aST @ZvAi- AND REF.ABILITATICt%l@
000 I 000 000 000'v
69. REPORTED BY- DENTON 70, PH : 000 0000
74. 4-i'@ENDANT NAME *I: 75. STATUS: 76. GRADE:
77. ACE; 7B. SEX-@ 70@A. 'Al: 79@ RELATIONSHIP TO PATIENTT
80. BAB TYPE: 81. BAG TAG 82@ BAG WT-
83. ATTENDANT NAV@.E @2: 84@ STATUS: 8@. GRADE@
66= AGE: 67@ SEX@ 87A@ V,'T: 88. RELATIONSHIP TO PATIENT;
69. BAB TYPE@. 90. BAB TAG #z 91. BAB WT:
92. TRANS OP,12 PHONE 4@@ 'CXT:
93. DEST PHONE @,: EXT:
9P,. ET ORTG MTF(DA-IE/TIMcl): 000 95@ CIA DEST MT@(r4ATP-ITIME): 000
.A 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