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File: 092396_aug96_decls14_0021.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
05-43;@-9 PATIENT FILE 1'1/29/90
1
PERSONAL DATA - PRIVACY ACT OF ic74
5 U.S.C. 552 (b)(6) IODEi A
1. NAME: 19. AL@IHORITY #: (1,36OA032 2@ SSANli 3. PRECEDENCE: R
4. STAT@ All GRADET E04 6. AGE: 2')Y 7. SEX; F S. WT: 135 9. READY DATE: 360
10. ISO: 11. PDR': 12. SPEC PAT;
14. RC@AS R@,B: DS 15. DATE !LAST VISIT; 16. CLASS: 3A
17, ACCEPT PHYS: Jt,',RO 19. APPT/SLIRG DATE: NO
O@0. A'@,iGV AJJTH: @01. P,ANC/IN'@: 22. VALID: -1@JH Y9
2--@ @@iTF DRIG: A5150 LISA DISPENSARY DP@AP@RAN 24. !CAO CRIG: BEDR
25z i4TF DEST., A5030 FRANKFURT ARMY RES MED 'z6. ICAO DEST: EDA.F
27. MED SPEC 1: SSG 26. DIAS 1: 6'o792 ADMISSION FD'@LC@ITN.C @!BORTTC[IN PERFORMED ELSE@'HC E, COMPLETE
R
29. @M@cD SP-PC 2: 0. DIAS 2:
31. riED SPEC 70: 32. DIAG @l:
3@zA. PROCEDURE:
34. IV:
,5. O'LILPM: N, 36. SUCT@ j@ 37. NG TUBE@ N 38@ RESPI N 39. FOLEY: N 4'v. STRYKER: N
41. INCUB: N42. TRACT: N 43. Ii@,ED: N 44. CAST/'LOC@ N 45. TRACHI N 46. ION: N
i@. PT BAB TYPE: NB 72. PT BAB TAB 73, PT BAB @IT:
41. BURP INFO: 366 TRANS F TPOLK PNT AT 85 EV
I LA
AC, REPORTED BY SUB-JMRO
48. @,AX ENRTC@ STOPS: Y / 9 49. ilAX @, RONS: Y 9 50. Al@T REST/@iAX HT: N
INPATIENT: Y 54. SPEC PROS: VA DRUB ALCOHOL WT NN@NIE X 55. VA C@DD-'-@
56. AD?iIN/GVc@RSEAS-.
56. VITAL SIGNS(TEMP/PULSE/,RESP/BLOOD PRESS): 097.8 70 16 110 70
59. HL'B: 60. HCT: @i. Afro; DATE TAKEN';
62. WBC@ 63. SI/VS!! 64. MEDICATIONS: NONE
65. HISTORY: COMPLETE ABORT TC,@,' 22 DEP 90. NEEDS RECOVERY TiriP. DR RE@ r,,M.EN.'
I - @O
OUT OF AOR TO CONUS FOR FAMILY SUPPORT
66. A,-i PHYS: BOSSCHER L@7. PH#.@ 000 000 IJOOO 68, @IARD#/PH#: 000 / 000 000 0000
69. REPORTED Dv: TSBT ROBINSON 70. PH#: 000 0000
74, ATTENDANT NAME #I: 75. STATUS: 76. GRADEI
78A. @l(': 79. RELATIONSHIP TO PATIENT:
80. BAG TYPE@ 81. BAG TAG 82. BAG WT:
83. ATTENDA T NAME 84. STATUS: 85. 6,RADE!
86- AGE: 87. SEX: 07A. WT: 88. RELATIONSHIP TO PATIENT:
89@ BAG TYPE: 90. BAB TAP@ 91. BAB WI;
92, TRANS GRIS PHONE EXT:
93. TRANS DESJ PHONE 4; EXT:
94. ETA GRG MTF(DATP/TIF@E)t 000 9-q. ETA DEST jITF(DAiE/TlimE): 000
97. OTHER CO@@liKENTSt
51. MSIN #@ 0000!361,1 @@2. RON LO@l:
57. VALIDATED BY/REAS FOR HIGHER r@@EF@DEN'@uE@
9L. 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