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File: 092396_aug96_decls14_0016.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
0'1;42:27 PATIENT FILE 12/29/90
P-tg@S0,NAL DATA - @ORTVA.@6y ACT Q;: 197@-I
5 U.S.C. 552 (b)(6) 13. @IODF@ A
I
i8. AUTHORITY #: 036IAOOS 2. S@-'PN: 3. PRECEDENCE: R
4. STAT: All 5. GRADE@ c@05 6@ AGE. 34Y 7. SEX: 'I B. WT: 2t'2 9. READY DATF-: 361
10. !So: 11. POR: 12. SPEC CAT:
14, REAS RES: DE 15. DATE LAST VISIT: 16. CLASS: @LB
17@ ACCEPT PHYS: 19, APPT/SURB DATE@ NO
20, @PPROV AUTHT 21. '@.ANC/INC: 22. VALID: Liyil! Y5
23. MTF BRIG: A5150 'USA DISPENSARY DHAHRAN 24. ICAD ORiGi OEDR
25. RITF DESTI A501n FRANKFURT ARMY REG MED 26. ICAG DEST: EDAU
27, M;-:D SPEC 1: iM.4iT@ L'B. DIAG 1: 35@l LUFfBOSA@,RAI@ PLEXUS LESIONS
'@',ED SPEC 2: 30. DIAG 2:
L9.,
31. NED SPEC 32. DIAB 3@
32A. PROCEDURE@
33, SPEC DIET: iN/ 34. IV:
02/LP.,i: N@ 36. Sl@'-C7]: N 7,7. NO TUBE: N 38. RESP: Ni 39. FOLEY: N 40, SIRYKER-. N
IT &,I
1. B: N 42. TRACT: N 4@o . T@
I 6u J- I iN 44, CAST/LOC: N 45. TRACH: N 46. N@ @l
, ED
71@ PT BAG TYPE; N-B 72. PT BAG TAB 7,-N. Pi BAB t4-i:
17@ SUPP INFO: ACO '/BTH CAV/GD, FT HOOD, TX //173 ViROll
1/8@@ EVAC//
48. MAX ENRTE STOPS- Y / 9 49. MAX # RONS: Y 9 50. ALT RESTI@AX H'i-: N
53. INPATIENT: Y 54@ SPEC PROP.: VA DRUG ALCO90L WT NONP X 5@'. VA CODE:
56. ADrIN/OV-LRSEAS:
58. VITAL SIG@NS(TEMP/PULSE/RESD/BLOOD PRESS): 098,L 1 64 16 / 142 64
59. FGB: 60@ H@@Tt 61, ABC: DATE TAKEN:
62. @49c: 63, SI/VST: f@4. &IEDI' TIONS: TYLENOL #3 PO 4PRN
@A
65, HISTORY: LONG HISTORY GP PACK PAIN' AND t@lul,'.BNESS IN' LEFT LEG, NOT RESPOND TNira,
To CONSERVATIVE TREATMENT, AE TO CO.-@US FOR EVAL AND POSSIBLE SURGERY.
66. ATT PPYS: SMITH 67, PH4: 999 999 9999 68. @IARDii/PH4t 999 999 999 9999
70. PH#-. 999 9999
74. ATTENDANT NAME 75. STATUS: 76. GRADE:
I 79. RELATIONSHIP TO PATIENT:
,7, AGE: 78. SEX: 78A. @-4T:
80. BAG TYPET 81. BAB TAG 82. BAr@' WT:
83. ATTENDANT NAME #2: 64. ST US@ 85. GRADE;
'AT
86@ AGE: 87, SEX: 87A. WT: 88. RE'-A'iqONSHIP TO PATIENT:
89, BAG TYPE; 90, BAG TAG 91. BAB 'AT:
92. TRANS BRIG PHONE -'-XT:
93. TRANS DEST PHONE 'ZXT:
94. ;-:IA BRIG mT,c'DATE/TIME): 000 95. ETA DEST MTF(DATE/T!,NE): 000
97@ OTHER COMMENTS:
ii. iviSN #-. 0000/361 52. RON '@OC:
57, VALIDATED BY/REAS FOR HIGHER PRECEDENCE:
96. AIRCRAF] 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