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File: 092396_aug96_decls14_0030.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
05:47tO'@ **** PATIENT FILE **** 12129/90
PERSONAL DATA - PRIVACY ACT OF 1974
5 U.S.C. 552 (b)(6)
i3. "ODE: A
'S. AUTHOR
NAME: ITY #: 036OA034 2. SSA@4: 3. PRECEDENCE: R
4. STAT: All 5. BRADE-, E05 6. AGE: 33Y 7. SEX: to, S. VJT@ 160 9. READY DATE: 360
10. ISO: 11. POR: 12. SFEC CAT:
i4. REAS REfi: DS 15. DATE LAST VISITI 16. CLASS: 2A
17. ACCEPT PHYS: JviRO 17. APPT/SURG DATE: NO
1
20. APPROV AUTH: 21. CANC/li@C- 2.0. VALID: I I TJH Y9
23. @T ORIS; A@15f, USA DISPENSARY DFAP.RAi',' 24. IP.AID ORIG-, OEDP,
.F 1
25. MTF DEST: A5040 "NID GEN HOSP LAilDSTUHL 26. TCAD DEST: C@DAR
27. riED SPEC 1: SOO 28, DIAG 1: 82'080 CLOSED FRACTURE O' UNSPECIFIED PART e-' TIBIA
29@ NED SPEC 2; 30. DIAG 2:
3', VED SPEC 3t 32, DIP.0 3,
32A. PROCEDURE:
34. IV:
5. 02/LPM.: N- 36. SUCT@ N 37. @N@6 TUBE: N 38@ RESP; 39. FOLEY: N@ 40. STRYKER: N'
41@ INCUB:N 42. TRACI: N 43. IMED: N 44. P@AST/'LO@@: N 45. -tRACHi N 46. riC-%': N
71. PT BAB TYPE: NB 72@ PT BAB TAG 77@. PT BAB V@IT:
47. S'u'PP INFO@ PIRIMASENS 0'a PINIT 41 85 @cV
AC, REPORTED BY SUB-iriRO
48. @AX ENRTE STOFS: Y 9 47. tiAX # RONS: Y/ 9 50. ALT RP.si-/t@,AX HT: N I
' 'INPATIENT: Y @ SPEC PROB: VA ',4T NONE X 55. VA CODE:
J3. @4 DRUG ALCOHOL
56. ADMIN/OVERSEAS:
56. VITA'. SIGNS(TEMP/PULSE/R@aSPID@,nn.D PRESS)I 098.6 1 60 / 16 / li2 86
59, HGB: 60, HCT: 61. ABS: I DATE @A EN:
6'4. WBC: 63. SI/VSI: 64. VEDICATIONS: Pt-ROOCEi 1-2 TABS PO DID
6i. 'HISTORY,. FOOTBALL INJURY @ilih CONCUSSICN. c@IP GRIF ric@DIAL TIBTA@ PLATEAU
AND BONE GRAFIING 19 DEC 90.
LEFT LONG 'LEE CAST APPLIED '@3 DEC 9'u'. BIVALVED
66. AT[ PHYS: MALCDII, 67. PF,#: 000 000 0000 68. WARD#/PH#t 000 / 000 000 0000
69. REPORTED BY: TSGT ROBINSON 70, PH#: 000 0000
74. ATTENID.A4T NAME #1: 75. STATUS: 76. CRADE:
I 78, SEX: 78A. 79. RELAIIGNSHIP TO PATIENT:
80. BAG TYPE; Bi. BAG TAG 82, BAB WT:
83. ATTENDANT NAME #2: 64. STATUS: 85. GRADE@
86. AGE: 87. SEX: 87A. L4T: 88. RELATIONSHIP TO PATIENT;
99@ BAB TYPE': 90. BAG AS 91. BAG @4T@
92. IRANS ORIG PHONE EXT@
93. TRANS DEST PHONE EX,:
94. ETA ORIrz tITF(DATE/TI@iE); 000 95, ETA DEST iMTF(DAIEITIME); 000
97. OTHER COMMENTS@,
51. MSN #: 0000/360 52. RON Ln@:
tE
@7. VA"IDA@ D BY/REAS FOR HIGHER PRECEDENCE'.
96. AIRCRAFT ITINERARY; 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