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File: 092396_aug96_decls14_0026.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
1
05:45@23 PATIENT FILE '2/'@9/90
PERSONAL DATA - PRIVACY ACT OF 1974
5 U.S.C. 552 (b)(6) 13. nD@: A
1. 13. AUTHORITY #: 0 6CA030 2. SSAN: 3. PRECEDENCE: R
4. STAT; All 5. GRADE! E04 6. AGE! 23Y 7. SEX: M 8. WT: 200 9. READY DATE: 360
10. ISO: 11. POR: 12. SPEC CAT: 1
14, REAS REG: DS 15. DATE LAST VISIT: 16. C' SS: 3A
LA
17. ACCEPT PHYS, JMRO 19. APPT/SURG DATE: NO
20, APPROV AUTH: III. CANC/INC: 22. VALIDI TJH Y9
2@'. j@iTF CRIS: A5150 USA DISPENSARY 24. ICAO DRIG: OPIDR
25. ?ITF DEST: A5040 l@ND GEN HO,'ZP LANDETLIHL 26. !CAO DESTT EDAR
27. t-'ic,D SPEC 1: SOD 28, DIAG 1; 71782 OLD DISRUPTION OF MEDIAL COLLATERAL L TGAMENT
29. iM7D SPEC 2: 30. DIAS -L:
riED SPEC 3: 32@ DIAG 3:
32A. PROCEDURP-@
3'@ SPEC DIET: i'@l/ 34. IV;
: N -o7@ NG TUBE: N 38. R-'@SP-. -N9. FOLEY: N 41,'). STRYKER. N
41, INCUB: iki 42, TRACTI N 4,-%. IMEDI N 44@ CASTI"OC: N 45. T@RACH: iN 46. MON@ N
71. PT BAG TYPET NIB 72. Fi BAG TAB 73. PT BA,'u WT:
47. SUPP INFO: HHC 464 FT STEWART GA PNT AT 85 clv
A@C, REPORTED BY Sl@'B-JteiRO
48. MAX ENRTE STOPS: Y 9 49. MAX # ROINS@ Y 9 50. ALT REST/VtAX HT: N
53. TNPATIENT@. Y 54. SPEC PROS: VA DRUG ALCOHOL @'T NONE Y, 5@@@ VA CODE;
56. ADMIN/GV,cRq-EAS-
VITAL SIGNS@TEMP/PULSE/RESP/ql.-DOD PRCISS); 098.6 78 16 / '08 72
57. HBB: 60. HOT: 61. ABS: DATE TAKEN:
62@ NBC: 63. SI/VSI: 64. MEDICATIONS: YIDTRIN 800 NG PC TID
65. HTSTORYG AR-IF@OSCOPY RT KNIEE@ T141STED RT KNEE 1 112 YEARS AGO. NU. @'T'H
PAIN
66. ATT PHYSI DORS'@IT 67@ PH#: 000 000 0000 68. WARD#IPH#: 000 / 000 000 0000
69. REPORTED BY: TS'OT ROB7NEON@' 70. PH#; 000 0000
74. ATTENDANT NAME #I. 75. STATUS: 76. GRADE:
77. ASET 78. SEX; 78A. t4T@ 79. RELATIONSHIP TO PAIIE@i'T:
80. BAG TYPE: 81. @q@48 TAG #t 82. BAG WT:
84. STATUS: 85. ORADE:
86. Ac@P@ 87. SEX: 87A. '@IT: 83, @RELATICINGHT@ TO PATI-PNT!
87. BAG TYPE: 90. BAG TAG 91, BAG WT:
92. TRANS DRIS PHONE 1: EXI:
93. TRANS DEST PHONE #: EXT:
94. CIA DRIG iMTF(DATE/TIrIE): 000 95. ETA DEST FiTF(DATE/TiriE)! 000
97. OTHER COMMENTS:
51. MSN #: 0000/360 52. RON LLJC:
@7, V@'.LIDATED DY/REAS FOR FDGP@ED PRECEDENCE:
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