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File: 092396_aug96_decls14_0019.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
05:4@ 23 PA TT Ek@'T FILE 12/29'90
PT119SONAL DATA. - PRIVA.1,Y ACT OF 1074
5 U.S.C. 552 (b)(6) '3. @@ODE: A
18. AUTP@D .
R,TY #: 036nAO47 2. SSAN: 3. PR'CCEDENP@c@.@ D
4, STAT: All 5. GRADE: E06 6@ AGE: 35Y 7. Sc@X; B. !,.,IT 200 9. READY DATE: 360
10@ 150: 11. POR: l@@. SPEC CP.T;
14, PEAS RES@ DS 15. DATE LAST VIST T: 16. CLASS: 2A
17. ACCEPT P'HYS: JMRO 19. APPTiSUR'u DATE: NO
20. APPROV AUTH: 21. CANIC/IN'@ 22. VALID: Tlq Y5
@3. @1,TF ORIG: A5150 USA DISPENSARY DHAHRAN 24. ICAD ORIG: OEDR
25. 4'TF DEST: F@@070 LISAFRMC WIESBADEN 'U'L 26. ICAO DEST@ cDAr'
CUS OF KNIEC', CURRENT
29. ilED SPEC 2: 30. DIAG 2:
7,i. riED SPEC 3@ 32, DIAG 3:
32A. PROCEDURE:
I , 1 @4. IV:
,3. SPEC DTE'L N/
35. 02/;,PiM@ N 36. SUCT: N 3i. NO TUBE: N '08. RF-C.P: j\l 39. FOLEY: N 40, STRYKER@ N,
41. INC'JB: N 42. TRACT: N 43. !DIED: N 44. CAST/Ln %l. 45, TRACH: N 46. K-Oil: N,
@c
71. PT BAB TYPE: N@4 72. PT BAG TAG 73. PT BAG WT:
47@ BURP INFO: D 'O 317 F-7NG@R APO OV757 // 85TH EVA.C// NO CAST//
48. MAX ENRTE ST@@-PS: Y / 9 49. @fAX # DON@S: Y 9 50. Al@T DEST/P',A.X HT@ N
UG A COHOL WT NONE ux 55. VA CODE:
@13, INPATIENT: Y 54, SPEC PROS: VA DR AL
56. A@MINIIDVERSEAS,.
56, VITAL SIONS(Tlcm@D/PULSE/RESP/BLOOD PRESS): 098,8 661 81 / Bfvl 72
59. HCD: 60. HCT: 61. ADD: I DATE TAJEN@
62. WDCG 63. SI/VSI: 64. MEDICAIICNS: ilOTRIN SOONG PO -[ID TYLENOL #3 PO ',I
4 PAN
6@-. d'SIORY@ INJURY WliH ACUTE HE.MARTHROSIS . ARTHROS'UPY REVEALED COMPLETE
DE II @,CL LAX'ETY OF IDD PIVOT SHIFT PNT NEEDS 6 WKS REHAB AND
DOM JOY BRAR,P- - OUT OF AOR
66. A't PHYS: MALCOLM 67. PH4,; 000 000 0000 68. WAR'u#/PH#; 00'@l / 000 000 OOCIO
69. R--POR I
,ED BY: DREYER 70. PH#: 000 0000
,-4. ATTENDANT NAME #I'. 75. STATU@ 76. GRADE;
77. AGE: 78, SEX@ 78A. @WT: 79. RELATIONSHIP TO PATIENT:
80. DAG TYP,cv 81. DAG TAG 62. BAD WT@
84. STAT S: 85. GRADE:
83. ATTENDANT NAME #2@ u
86. A69i 87. SEX: 87A. WT: 88. RELATIONSHIP TO PATIENT:
89. BAB TYPE: 90, BAG TAG 91. BAG WT:
92. TRANS ORIG PHONE 4: E@'T:
93. TRANS DEST PHONE #: EXT:
94. ETA NRIG MTF@DATEITI@IE): 000 95. ETA DEST MTF(DATEITIME); 000 f
97. OTHER COriMPNITS:
N"N t:
@i. @,O 0000/360 @@2. RON LO'@;
VALIDATED BY/REAS FOR HIGHER PRECEDENCE:
9L. AIRCRAFT ITINERARY: I
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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