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File: 092396_aug96_decls5_0012.txt
Subject: PATIENT FILE
Box ID: BX000482
Document Number: 4
Folder Title: MEDSTAT - SITREPS DEC 90 4 OF 6
Folder Seq #: 8
Unit: ARCENT
Parent Organzation: CENTCOM
@IFk@'T FILE 12/29/90
1 @
PERSONAL DATA - PRIVACY ACT OF 1974
13. i4,ODE@ A
1. NAME; 18, AliTPGRITY #: 0 57AOO3 2@ SSAN: 3. PRECEDENCE: R
4. STAT; All 5. GRAD@--. E03 6. AGE: 23Y 7. SEX; M S. WT: 148 9. READY DATE: 357
10. 190; ll@ PDR. i 12. SPEC CPT. i
14. R;-:Ag REG: DS 15. DATE LAST VISITI 16. CLASS: 29
17. ACCEPT PHYS,. JR@RD 5 U.S.C. 552 (b)(6) 19. A.PPT/SURS DATEI NO
20. APPROV AUTH: 2'. CANC/IN,'C@ 'L2. VALID: CWH Y5
1 MD
@3. MTF CRIS: A5150 USA DISPENSARY DHAP@RAN 24. !P@AO ORIi-z: O' R
E 26. ICAO DEST: EDAF
IF
27, F@ED SPEC 1: SOD 29. DIAS 1: 82@'21 CLOSED FRACTURE C,' AO.TRAGALUS
29, McD SPEC 30. DIAS 2.,
31@ Mc,D SPEC 3: @,2. DIAG
32A.. PROCEDURE:
@3, SPEC DIET: N/ 34. !V:
35. 02/LPM; N@ 'o6. SUCT: ik", '@7. NB TUBC@@ N@ 38. RESD: N 39@ FOLEY: N 40, STRYKER: N
41. !NCUB@ N 4L. TRAC-1@ \1 43. IMED2 N 44. OAS]/LOC-. Y RS'l- 45. TRACH: N 46. ik'iON: N
71. Pi BAB TYPE. iNB 72. PT BAG TAG 4: 73, PT BAB T:
47. SLIPP LiN@cO@, FT P@OOD, TX 2@' CSHII
49. MAX ENRTE ST@@PS: Y 9 49. MAX # RC'NS: Y / 9 @@o. ALT RESTIMAX HT: N'
53. INPATIENTI Y 54. SPEC PROG: VA DRUG ALCO.4,OL 1,4T @N'@@NE X 55, VA CODE:
56. @.D@IIN/GVERSc@AS:
58. VITAL SIGNS(TEMP/PULSE/Rc@SP/B@OOD PRESS)I 096.0 60 / 16 / 104 60
59. 'iBB: 6Ci. H.CT: 6i. ABS: DATE T.AKEii-@
62. NBC: 63. BI/Vgl@ 64. MEDICATIONS: i@Cf'.E
6i. HISTORY: FELL 15 FEET DIGHT ANKLE - C@STED 18 DEC 90 AND
BIVALVED
67. PH#: 000 000 0000 68@ WARD#/@"'J#@ 000 OCO 000 0000
69. REPORTED BY: DREYER 7 .P144: 0 C., 0000
74. ATTENDANT iNAr.E #I: 7@. STATUS: 76@ GRADE:
,7. AGE: 78. SEX: 76A. kT: 79. RELATIOT@,SHIP TO PATIENT:
60. BAB TYPE: 81. BAB TAB 62. BAG @)T@
83. ATT t%DAi'@T NAME 42t 84. STATUS: B5. GRADE:
,E
86. ACE: 87, SEX: 87A. @JTI BB, REI,ATIO@N'94IP TO PATIENT;
89. BAG TYPE@ 90. BAB TAG 91. BAB 14T:
92, TRANS ORIG P,@CINE EXT@
I.. TRANS DEST PHON"-- EXT;
?4. ETA @U@RIG iMTF(DATE/TIME): 000 1 95. EiA DEBT MTF(DAT /T'riE)@ 000
97@ OTHER
51. MEN #: 0000/357 52. RON "OCi
57, 'IP.LIDATcD BYIREAC@ FOR HTGrF,@' FREP-IDEtiCE: i
96@ ATRN AFT ITliNFRARY:
OR
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Document 18 f:/Week-32/BX000482/MEDSTAT - SITREPS DEC 90 4 OF 6/patient file:09069614061216
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 # = 16
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