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File: 092396_aug96_decls14_0027.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 14@/29/30
P@@RSU@iA@'L D,@T - PRIVACY ACT OF 1974
,A
5 U.S.C. 552 (b)(6)
I'@. @inDE: A
T
1. NAME 18. AUTHORITY 4: 035BAO@@' 2. SSANT 3. PRPCEDENICE: R
4. STAT: All 5. GRADE: E03 6. AGE: 20Y 7. SEX: 8. WT: 13o' 9. READY DATE: j5S
1 @). ISD,@ li. PILD,: @ I 12. SPEC CA-):
14. @REA'A R,@ai DS 15. DATE LAST VISIT: 16. CLASS: @A
17. ACCEPT PHYS: JMRD 19. APPT/SLIR'u NO
20. APPROV AUTH-. 22. VALID; I Tid Y4
24. ICAID GRIG: GP-DR
25. IMTF DEST: A5100 @IU-tRENB,--RG A,@-,H 26. ICAO DEST: EDDN
21. riED SPEC li SOD 28. DIAG 1: 71783 OLD DISRUPTION OF ANTERIOR CRUPIIATE LIGAMENT
29. i'@a'D SPEC '@. 30. DIAS 2@,
31. riED SPEC 3: 32. DIAS 3:
32A. PROCEDURE:
33. SPEC DIETT N/ 34. TV:
0. O-z/LPM: N 36. SUCT- 37@ t4G TUBE: N 38. RESP: N 39. FOLEY@ N 40. STRYKER: N
41, L@NCUB: N 42. TRACTT N' 43. !M.ED: i@ 44. CAS-i/LSC: N 1 45. -IRACH@ @l 46. @ON: N
71. PT BAG TYPE: @4D 72, PT BAG TAG 73. PT BAS k'T@
47. SUPP INFO: 20'TH MI BE@- FE /85 EVACI" NO CAST
46. MAX E@4P,-IE S10,05: Y 9 49. MAX @ RON'D, Y 1 9 50, ALT PEST/MAX HT: t@.,
INPATIENT: Y 54. SPEC PROS: VA DRUG ALCOHOL 6T NONE X 53. VA CODE@
,Q 4
@@6. ADt'ij4/DVERSEAS:
58. VIT L SIGNS(TEMP/PULSE/RESP/BLOOD PRESS!: 099.4 64 /16 / 100 53
.A
59. HGEI 60. @'@@Ti 61. ADG: f DATE TAKEN:
63. SIIVSI. 64. MEDICATIONS @4APROEYill 250riri PC BID
6@@@ HISTORY: 5 WEEK INJURY TO LEFT KNEE - CONTUSION / INSTABILITY.
l@','JLI@RY Orl@URED PRIOR TO DEPLOYMENT IN GERMANY
66. ATT PHYS: PERRY 67. Pd#: 000 000 0000 68, @IARD#/PH#.: 000 I 000 000 0000
69. REPORTED Bl'! DREYER 70. PH#: 000 OOOC.,
74. ATTENDANT NAME #I: 75. ' ATUST 76, GRATI@@
ST
77. ACE: 76. SEX: 78A. V,'T: 79. RELATIONSHIP TO PATIENT:
80. BAG TYPE: 61. BAG jAG #i 82. BAG '@,'T:
83, ATTENDANT NAVE #2t 64. STATUSI B5. GRADE:
86. AU : 87@ SEX! 87A. @.lJT2 88. RELAIIONSHIP TO PATIENTI
89. BAG TYPE@ 90. BAG TAG 91. BAG '@,.'T:
92. TRANS CRIS PHONE EXT-
9,i @TRANS DEST PHONE EXT;
ETA PEST @MTF(DAT7-/TIME): 000
97@ OTHER COMMENTS:
n
51. 46,N #,. 00001358 52. RON L'u.:
57. VALIDATED BYIREAS FOR HIGHER PRECEDENCE:
9'0. AIRCRAFT ITINERARY; f
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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