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File: 092396_aug96_decls14_0017.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
@j:4.0.46 **** PATIFF@@ FILE **@* l.'j2Dj9O
PERS,)NP,'- DATA - PRIVAL-V ACT Oc 1974
U.S.C. 552 (b)(6) 13, Mi@'DE: A
n
1. NAM-@: 18, AUTHORITY #; 036IAOO9 2. S@@ANT 3. PRECEDENCE: R
4@ STAT@ All 5. GRADE: EO" 6. ABE: 19Y 7. SEX: M B. ,4T: 179 9, READY DATE: 361
@0. ISD,, 11. POR. 12. SPEC CAT.
14@ REAS REG: DS 15. DATE LAST VISIT: 16. '-LASS: ',A
17@ ACCEPT PHYSI 19. AFPT/SURG DATE: NO
AFPROV AUTH: 21. 22@ VALID: Li@K Y3
@7
MTF BRI@- A5150 USA DTSF'ENSARY DHAHRAN 24@ ICAD CRIG: OEDR
@5. VITF DEST: F5070 USAFci@'C 'AIESBADEN GE 26. IC.40 Dc'ST-. EDAF
27. M-ED SPEC It 600 28. DIAS 1: 71941 PAIII IN o'GINT INVOLVING SHOULDER REGION
29. PIED SPEC 2: -10. DIAS 2:
@A@r 3:
,@l@ NED SPEC 3; 32@ DT
,@2.A. PROCEDURE:
34. IV:
35. 02/LPiN- N' 36, SUP@TT N 37. NS TUB-'-: N 38. PESN N 39. FOLEY: N' 40, STRYKERT N
41. INCUB: N 42@ TRACT: N 43. liviED: 4 44@ CAST/LOC: N 4@'. T A@ @. N 46, N
.R @H
71. PT BAG TYPE; ND 72. PT BAG TAG 73, Pi DAB WT:
47. @OUPP INFO: I./15YTH AVill @RES, FT BRASOP, NIC /117,-% @'jRG/l
//85 EVAC//
48. MAX EINRTE STOPS: Y / 9 49. MAX # RONS: Y 9 @-0, ALI REST/@AX uT: N f
5'. 1.@-PA'IENT-, Y 54, SPEC PROS: VA DRUG ALCOHOL VIT NONE X 55. VA "ODE:
36. AD@miIi\'/GV'c-RSEAS@
58. VT@ L SIGNS(TEMP/PULSE/RESP/B:.ODD PRESS); 098.4 76 2(l, 1 "O 76
,iA 1.
59, HOB: 60. HOT: 61. ABB: DATE TAKEN:
62. NBC: L@3. 64. @IEDICATIC,\'S@ YICTRIN SClOYiG PC TID
65. HISTORY: PAINFUL RIGHT SPOULDEF,' X 7 MONTHS MAY RECUIDE SURGERY EXTENSIVE
@REHA
AD.
66. ATT PHYS; DORSEY 67. PH#-. 999 999 0999 68. WARD#/P@#- 999 / 999 999 9999
69. REPORTED -BY: SGT 0,9.@GiT 70. PH@: 9@? 9997
:
77. AGE, 76, SEX: 76A. WT: 79. RELATIONSHIP TO PA-;!ENT:
80. BAG TYPE: SI. BAB TAB 82. BAG WT:
63. ATTENDANT NAME #0@: 64. STATUS: 65, GRADE:
86. AGE@ 87. SEX: 87Av WT: DS. RELATIONSHIP TO PATIENT:
89. BAB TYPE: 90@ BAG TAB 91. BAB WT:
92. TRA,@IS CRIG PHONE CA I ! i
93. TRANS DEST PHONE EXT:
94. ETA DRTP MTF(@ATE/Tl -)i 0011 95. ETA DEBT riTF(DATE/T't@c): 000
I0 u a
97, OTHER CDMViEtITSt
@.l@ #,. 00001361 52. RON LO'U:
57, VALIDATED BY/DEAS FOR V,!Gh'F-R PPa-LEDc CE:
I @N
96. AIRCRAFT ITINERARY: I /1
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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