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File: 092396_aug96_decls14_0028.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
C@,@ 46 - 0-@ **** PATIENT FILE **** il@l/.@91,90
PERSONAL DATA - PRIVACY ACT Q@ i974
5 U.S.C. 552 (b)(6)
ti. MODE: A
1. '8, AUTHORITY #: 036OA028 2. SBAN: . PR'CCEDENCET R
4. STAT: All 5. 8,RADE: E04 6. AGE: 20Y 7. SEX: i',! B. WT: 160 9. READY DATEI 360
ISO. 'i, PDR@ i l@'. OPEC CAT.-
14@ REAS RES: DS 15. DATE LAST VISIT@ 16. CLASS: l@A
17. ACCEPT PHYS, u'MDG 19. APPIISURG DATE; ND
iq
APPROV AU' 21. P@ANP@IINC: 22. VAI ID- f TUH Y9
@3. rTF DRIG@. A5150 USA DISM- SARY DHAHRAN 24. ICAD GRIG: OEDR
25. MTF DEST: F5070 USI@FRI@C !ATF BADEN GE 1,6. ICAO DEST: EDAF
I-S
,7. -@ED SPEC 1: SOD 26@ DIAS 1: 8362 OTHER TEAR Or' CAP,, !LA.,-iE OR VIEN'SCLI.0 OF KNEE, CURRENT
29. 'IFD SPEC @'. 30. DIAS O@-
'I. M@ED SPEC 3: 311. DTAG 3:
32A. PROCEDURE:
-%4. IV:
Z5. 02/!IFM: N 36, SUCT@ K@ 37. NS TUBE: N 3-B. RESP- N -@9. FOLEY: 40. STRYKER: N@
41. TNP@UB: N42. TRACT: N 4 . !M.EDI N 44. CA.STILDC: Y L'@L 45. TRACH: N 46. MON: N'
71. PT BAB TYPE; ND 711. PT BAG TA 73. PT BAG WT-,
47. SUDP INFO: @HC 432 ENCR FT BEIV.\II.NG CA PNT AT 65 Ek;
AL-;, REPORTED BY SUB-JMRO
48. MAX ENRTF STOPS@ Y / 9 49. MAX # RONSI Y / 9 50. ALT REO@T/ AX HT; N
53. INPATIENT: Y 54. SPEC PROG: VA DRUG ALCOHOL WT NONE X VA CODE:
,6. ADMINI/OVERSEAS:
58. VITAL SIGNS(TEM@P/P'u'LSE/R@aSP/PLOOD PRFSS)I 078.8 80 1 16 10,@ 68
59@ @BB: 60. HCT: 61, ABS: DATE TAKETN'@
62. NBC: 63. Er/VSI: 64. MEDICATIONS: i4li3TRI@44 BOVIG PR,@4
6'@. HTSTO' ; LES T NOURY 22 DEC PLAYING VCLLEYEALL, OP UIRES SURGERY AND REHAB
i,Y
CUT OF AOR.
LEFT LONG LEG CAST APPLIED 24. n@ go.
.EC
66. ATT PPYS: DORSEY 67. P.H#: 000 000 000(i 68. WAPD#/PH#: 000 / 0110 000 @)OOO
69. REPORTED RY: ISGT ROBINSON 70. Pff#: 000 0000
74. ATTENDANT NAME *I: 75, STATUS: 76. GRADE:
T: 79, RELATIC@NSP.IP TO PATIETNT@
80. BAB TYPE: 81, BAG TAG 82. BAG WT:
83. AITENDANT NAME #2: 84. STATUS: 85. GRADE:
86, ACE: 87. SEX: 87A. @,'T: 86. RELATIONSHIP TO PATIENI:
89. BAB TYPE: 90. BAG TAG 91. BAB @T:
92, TRANS CRIG PHONE 4: EXT:
93. TRANS DEST PHONE #-. EXT:
94. ETA ORIG tiTF(n,ATE/TIrii.:)t 000 95, ETA DEST MTr@(D,@TEI'TMF)@ t)of)
77. OTHER COMMENTS:
51, @toN #@ 0000/360 52. RON LOC@
57. VALIDATED BYIREAS FOR HIGHER PRECEDENCE: f
76, 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