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File: 092396_aug96_decls14_0029.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
05@46:40 PAT IE@.\@ FILE 12/29/50
1 i I
PERSONAL DATA - PRIVACY AC@ OF 1974
5 U.S.C. 552 (b)(6) A
1. NIA@IE@ 18. AUTHORITY #: 036OA03'@ 2. SSAN: 3. PRECEDENCE: R
4. SiATi All 5. GRADE: E06 6. AGE: 34Y 7. SEXI 11 S. WT: 135 9. READY DATE! 360
10. ISC@: 11. POR: 12, SPEC PAT. 1
14@ R-PAS REB: DS 15. DATE LAST VISIT: 16. CLASS: 3A
17@ ACCEPT PHYS@ Jt4RO 19. APPT/SLRO DATE: NO
20, APPROV AUTP@: 21. CA.NC/T@l: 22. VALIDI TIH Y9
17 24, ICAD ORIE: CEDR
NTF ORIC. A5150 USA DISPENSARY DHAHRAN
25. MTF DEST: A5040 2ND GEN HOSP LANDSTUHL 26. !CAO DEST: ;-:DAR
27. MED SPEC 1: 26. DIAG 1: 49390 ASTHMA, UN'C@PECIFIED TYPE, STATUS ASTHO.ATICUS NOT MENTICNED
29. M-LD SPEC 2: 30. DIAS 2:
D SPEC 3: 32. DIAS
32A. ORDCEDURE:
33. SPEC DIET: @%ll 4. IV:
3@@. 02/LPM. N' 1 36. SUCT: N' 37. NG TUBE: N 36. RESP: N' 39. FG'LEYT N' 40. STRYRER:
41. TNCUB: N 42. TRACT, N 43. TMED: N 44, CAST/LOC: @,i 45@ TRACH: N 46. MON: N
71. PT BAD TYPE: NIB 72@ Pi BAD TAG 1-3. PT BAD WT:
47, SUPP INFO: 307 II DN APO iNlY 09107 PNT AT 85 EV
A
'I, REPORTED BY SUB-iriRD
48. ilAX ENRT'L STOPS: Y / 9 49. i'IAX # RONS: Y .1 7 50. ALT REST/i'IAX HT: N
@3. INPATIENT: Y 54@ SPEC PROG: VA DRUG ALCOHOL WT NONE X 55. VA CODE:
36, ADPIIiN/OVERSEAS:
58. VITAL SIGNS(TEMP/PULSE/RESPIBLn@OD P@RESS)@ 0?6.6 80 / 20 120 88
59, HGB: 60. H.CTT 61. ABG: DATE TAKEN:
62. WBCT 63. S'/VSI: 64. rfEDICATIOiNg-. THEODYR 300.'IG BID; PR'Uvc,,I-IAL
!NH.ALOR 2 FIJFFS ri!D; PREDISONE 200 MG BID
65. HISTORY: UNABLE TO SURVIVE IN CHEMICA @IARFAR- ENR'VONM NT. NEEDS
AL I ME
PULMONARY WORR-JP. PC-SSIBLE @',r,7B/Plcs REQUIRED.
66, ATT PHYS: ROLFE 67, PH#: 000 000 0000 68. JAARD#IPH#; 000 / 000 000 0000
70. PH.4: 000 0000
74. ATT@cNDANi NAME #I; 75. STATUS: 76. GRADE:
77. ABE. 78. SEX: 78A. WT: 79@ RELATIONSHIP TO PATIENT:
80. BAG TYPE: 8'. BAG TAG #i )82. BAG WT:
8@@. ATTENDANT NAME #2! 84. STATUS: 65. GRADE:
86, AGE@ 87. SEX: 87A. W'i 88. RELATIONSHIP TO FATIENT:
89. DAG TYPE@ 90. BAB TAG 91. BAG WT:
7-@. TRANS ORIG PHONE EXTT
93. TRANS DEST PHONE EXT!
?4. ETA ORIC MTF(DATE/TIME): 000 9@@. ETA DEST MTF(DATE/TI,@'t'-): 000
97. OTHER COMMENTS:
51. I.,ISN @: 0000/360 52. RON' LOC:
57. VALIDATED BY/REAS FOR HIGHER 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