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File: 092396_aug96_decls14_0023.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
L@5:44:30@ **** PATIENT FILE **** @l/@L9190
PERSONAL DA$A - @RIVACY ACT n@@- 1974
5 U.S.C. 552 (b)(6)
13. A
1. NAME: 'S. A@IJTP@rjRITY 036!PCll@) 0. SSAN: 3, PRECEDENCE: R
i
4. STATI All 5. GRADE: c@04 6, AGE; 'L9Y 7. SEX: M S. WT: 180 9. READY DATE: 361
io, ISO. 11, PDRG 12. SPEC CAT:
14. REAS REG: DL; 15, DATE LAST VISIT: 16. CLASS: '@B
17. ACCEPT PHYS: 19@ APPT/SLIRG DATE: NO
.0. APPRCIV ALIT4@ 21. O@ANC/IN@-1: 22. VALID: 1 LilK Y5
23, MTF 0018@ A5'50 USA DISPENSARY DHAHRAN! 24. ICAO ORIG: OEDR
25. MiF DEBT: A@@,40 2ND GEN 4090 LANDSTUHL 26. ICAD DESTI EDAR
21. MED SPEC 1: BOOH 28. DIAG 1: 6171 t@i!JLTIPLc, 'FEN FRACTURES OF HAND BONES
81600 CLOSED FRACTURE OF PHALANX OR P@uAL,4i%'SES OF UNSPECIFIED
31. SPEC 3: 32. DIA
32A. PROCEDURE:
33. SPEC DIETI NI @,4. IV:
35. 02/LPM: N 36. SUCT: N 7. Nt-3 TUBE; N 716. RESP: N 39. FOLEY: N 40. ST.RYVE@RZ N
41. I'l@@UB: N 42, TRAC": .N 43, l@,EDi N 44. CAST/LGC: N 1 45. TRACH: iN 46. VION: ti
71, PT BAB TYPE: NIB 72. PT BAB TAG 73. Pi BAG WT:
47. SVPP liNFO., 98ST,4 SUPPLY PC, FT STENA@RT, ER 41RO//
/185 EVAC//
49. MP.X ENRTC@ STOPS: Y / 9 49, MAX # RC[INS: Y / 9 50. ALT REST/MAX HTt N
o3. 114PATIENT: Y 54. SPEC PROG. VA DRUG ALCOHOL WT X 55, VA. CODE.
56. ADmIN/DVERSEAS;
Is. VITAL SIGNS(TEMP/PULSE/@RESPIBLOOD PRESS): 09P.4 60 / 12 110 1 70
19, HGB: 60. H.CT: 61. AB@o: DATE TAYENI
62. 14BC: 63. El/VSI: 64. MEDI@'ATION@- ilO@-Rltl BCJCJ.MC TID, PUBCD.AN 04-6H Pfl,,@
6@@. HISTORY: ADMITTED FCR LBP, FELL, IN LATR!t,'E. UNSTABLE FRACT RE OF 3RD AND 4T
@u
P. DIGTT , WILL @ VE DIFFICULTY WITH PROIECTIVE MAS'N@ AND WILL Rc@Q'u'IRE PORLONSE
@@s . @A
D CONIVALEO@Ch-.QP-.
67. PH4@z 999 999 9999 bg. IjIARD#/P4@: 999 999 997 9999
69@ REPCRTED BY: EST ABBOTT 70, PH#: 990 3799
74, ATTENDANT NAME #I-. 75. STATUS: 76@ GRADE;
77. AGE; 78, SEX: 78A. ',IT: 79. RELATIONSHIP T PATIE,4T.
80. BAG TYPE: 81. BAG TAG 82. BAr,' WT:
B3. ATTEtNDA@k,'] NAME #2: 84. STATUS: 85@ GRADE:
26. AGE: 87. SEX: 97A. WT: 88. RELATIONSHIP TO PATIENT:
89. BAG TYPE: 90. BAG TAG 91. BAG WT:
?2. TRANS CRIS PHONE EXT:
93, TRANS DEST PHONE EYT:
94. ETA ORIS MTF(DATE/Tir@E); 000, 95. ETA DEST MTF(DATE/T TME)@ 00t)
97. OTHER
51= MSN 1: OC@00/@61 5'.. RON LgL-,@
57. VALIDATED BYIREAS FOR HIGHER PPECEDE@,@CE.
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