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File: 092396_aug96_decls14_0025.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
**** PATIENT FILE **** 12/29/90
PERSONAL DATA - PRIVACY ACT OF i974
5 U.S.C. 552 (b)(6)
13. MODE! A
l@ NAVEI 16. AUTHORITY #: 0360PO'.9 2. SSAT@: 3@ PRECEDENL@EE P,
4. SIAT: Al' 5. GRADE: -@-04 6. AGE: 27Y 7. Sc@X,. @vi 9. @,'Ti 15C, 9. READY DATE: '@60
10. ISO, I 1. PD.R, 12, 'OPEC CAT:
14, REAS RES: DS 15, DATE LAST VISTT: 16. Cl-A.F-: 3A
17. ACCEPT PHYSI JNR'C 19. AFFT/Si,'RG DATE: NO
20@ APPROV AJTH: 21. CANC/INC; 22@ VALID: TJH Y9
23, MTF DRIGT A5150 USA. DISPENSARY DHAHRAN 24. ICAD ORIG: GEDR
25. FITF Dc@sT@ A5100 NLIEREINDERG ACH. l@6. ICAO DEST: EDDIi'
27, NED SPEC 1: SSD 26. DIAS 1: 5269 UNSPECIFIED DISEASE OF TH@ JAI@
29. NED SPEC 2: 30. DT
,@AS 2.-
,@l. NED SPEC 3-@ 32@ DIAG 3:
32A. PROCEDURE:
33. SPEC DIET: MI 34@ IV:
@5. 02/LPri; N I SUCTT N' 37. NS TUBE: N 36, RCSP: K@ 39. FOLEY; N 40. STRYKER: N
41. TNCUB. N 42. TRACT: N 43 . TNED: N 44. CAST/LQCi N 1 45. TRACU: N 46. MON: i\l
71. PT BAB TYPE: NB 72. PT BAB TAG 73, @T BAB tIT:
47. SUPP INFO@ C CO 3/327 INF FT CAMPBELL KY PNT AT 85 EY
Ar@, REPORTED BY SUB-JRRO
48. MAX ENRTE STOPS: Y 11 9 49. MAX # RONSI Y 9 50. ALI REST/.MAX HT; N
53. TNPATIENT: Y 'i4@ SPEC PROG: VA DRUG ALCOHOL WT NONE X 55, VA CODE:
56@ ADM@IN/GVERSEAS:
53. VITAL SIONS(TEMP/PLI'@GF-/REEP/BLn@OD PRESS); 098.0 1 60 LI / 110 70
59. HGB-. 60. HOT: 61. ABG: DATE iA'.KEN:
62. WBC- 63. El/VSI., 64, @',EDICAIIGNS: PEROCA@AN 1-2 TABS -@G 0 PRN, KEFLEX
250 MG PO DID
65, HISTORY: SIP FACIAL TRAUMA @IAN 90 WITH FX iMAXILLA-ZYGw',IA. NOW HAS SEVERE
POST REDUCTION' PAIN, CANNOT PERFORM DUTIES,
66. AT T 0 YSI PA@LTOW 67. PH#: 000 (100 0000 68. WARD'ff/PH#: 000 000 000 0000
, H
69. REPORTED BY: TS(3T ROBINSON 70. PH#: 000 0000
75, STATUS: 76@ GRADE:
77. AGE: 78. SEX: 79A@ @JT: 79. RELATIONSHIP TO PATIENTI
80. BAG TYPE: 81. BAG TAG 82. BAG 'k4T:
B@ ATTENDANT NAME 42: 84, STATUS: 8@'. BRADE:
86, AGE: 87. SEX: 97A. WT: 83. RELATIONSHIP TO PATIENT:
69. BAG TYPE: 90. BAG TAG 91, BAG WT:
92. TRANS CRIG PHONE 4; EXT:
9-1. TRANS DEST PHDl@,p7 #1 EXT:
94@ ETA ORTG i@TF(DATE/TI@IE): 000 9@-@. ETA DEBT MiF(DATE/T!VjE); 000
97. OTHER CO@MMc,NTS.-
18i\l #: 0000/360 52. RON LOCI
57, VALIDATED BY/REAS FOR @4IONED PRECEDENCE:
96@ AIRCRAFT ITINERARY: f 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