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File: 092396_aug96_decls14_0015.txt
Subject: PATIENT FILE
Box ID: BX000482
Document Number: 2
Folder Title: MEDSTAT - SITREPS DEC 90 4 OF 6
Folder Seq #: 8
Unit: ARCENT
Parent Organzation: CENTCOM
05.421-07 PATIENT F'LF '2/2Q/90
PERSONAL DATA - PRIVACY ACT C@ l@74
5 U.S.C. 552 (b)(6)
171, IMDE: A
r
1. NAME: 'B. AUTHORITY #: 036IAOO7 2. SSAN-. 3. PRECEDENCE: R
4i STAT: All 5. BRADE! E04 6. AGE: 26Y 7. SEX: B. WTi 160 9, READY DATE: 361
10, !SD.@ 11. POR. 12. '-;PEE L-,AT.@
14, REAS REG: DS 15. DATE LAST VISIT: 16. CLASS: 3A
i7@ ACCEPT PHYS: 19, APPTISURG DATE-. NO
20. APPROV AUTH-. 21. P,ANCIIN@-: 22. VALID: @'-@'iK I' Y@@
23. Mi-F CRIB: A5150 USA DISPENSARY DHAHRAN 24. ICAO CRIG: OEDR
25. MTF DEST: F5070 USA;:IRMC WIESBADEN BE z6. ICAO DEST@ EDAF
4 @,ED SPEC 1: Mri@i 28. DIAG 1: 49,-)90 ASTHMA, UNSP-- ',@IED TYDC
IC- STATUS Ac@-iH@IATI-uUS NOT MENTIONED
01:
31. @iED SPEC 3: @2. DIAG 3:
3--@A. PROCE'UUREG
33. SPEC DIET: N/ @4, !V:
'05. 02/LPM: N 36, SUCT@ N 37. NG TUBE: kl 38. PESP: N 39. FULEYT N 40. STRYK@-RT N
41. INCUB: IN 42. TRACT: if 41 it!ED: N 44. CAST/L'uC@ N 45. TRACH: N 46. MON: N
71, PT DAB TYPE@ NB 72@ PT DAG TAB #t 77@. Pi BAB WI:
47. SLIPP INFO., 598@H t,',AINT@ FT BENINTiNg, CA 1/17.3 ik,RO//
//65 EVAC//
48@ V@AX Ei'@RTE STOPS: Y / 9 49@ TAX # RONS: Y 9 50. ALT REST/iMAX 4T; N
57. INPATIENT: Y 54. SPEC @DROB: VP. DRUG ALCOHOL W@ NIG,,\E X '@5. VA CODE:
56. AD@tI@4/OVERSEA@
58. VTT L SIG?16@Tc P/PULS-/Rc@SP/BLOOD PRESS): 099.@ / 73 12 / 120 60
,@A @v, r 1
59. HGB: 60. HCT: 61. ABS: I DATE TAKEN:
6'4. NBC: 6'. 64. MEDICATIONS: IH.EgBiR 700elC BID; PR'GVENTTL INHALE
R 2 PUFF DID@ PREDINIZO@N@E 20@S BID
65. HISTORY: HISTORY OF ASTHMA CONTROLLED WITH ':HEODLIR AND PROVENTIL INHALER IN
CONLIS, REOCCURENCE FREQUENT IN' C@@'UiNTPY. @,HEE7Tt\lG EVEN ON PREDNIZONE, CANNOT
PERFORM DUTY IN SAUDI ARABIA
66. ATT PHYSI ROLFES 67= PH#@ 999 999 9999 68. WARD#/PH#: 999 / 999 999 9999
69. REPOOTED BY: SGT ABBOTT 70. PH#: 999 9999
74. ATTENDANT NAME #I: 75. SIATUS: 76, GRADE:
77. ABE. 78@ SEX: 18A. @4T: 79. RELATIONSHIP TO PATIENT:
80. OAB TYPE; 81. DAG TAG 82. BAB WT:
83. ATTENDANT NAME #2: 64. STATUS-. 85. GRADE!
86. AGE: 87. SEXI 67A. WT- 88. RELATIONSHIP O PATIENT;
89. @4i TYPE: 9(). BAB TAB 91. BAG WT:
92. TRANS ORIG PHONE EXT:
93. TRANS DEST PHONE EX'@:
94. ETA n TS MTF(DATc/TIME): 000 95. ETA DEST MTF(DA' /TljlE)! 000
.R,
97, OTHER COMMENTS:
51. MSN #: (iOOO/361 92. RON LO@l:
57. VALIDATED BYIREAS FOR HIGHER PREFEf,'ak(CE@ i
96. AIRCRAFT ITINERARY:
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Document 30 f:/Week-32/BX000482/MEDSTAT - SITREPS DEC 90 4 OF 6/patient file:09069614064231
Control Fields 17
File Room = aug96_declassified
File Cabinet = Week-32
Box ID = BX000482
Unit = ARCENT
Parent Organization = CENTCOM
Folder Title = MEDSTAT - SITREPS DEC 90 4 OF 6
Folder Seq # = 8
Subject = PATIENT FILE
Document Seq # = 31
Document Date =
Scan Date = 14-AUG-1996
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 = 06-SEP-1996