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File: 092496_aug96_decls4_0012.txt
Subject: PERSONAL DATA PRIVACY ACT OF 1974 4 JAN 91
Unit: ARCENT
Parent Organization: CENTCOM
Box ID: BX000460
Folder Title: MEDSTAT- SITREPS - JANUARY - 1
Document Number: 10
Folder SEQ #: 2
16:16:16 PATIENT FILE 01/04/91
PMNL DATA - PRIVA.@ ACT OF 1974
5 U.S.C. 552 (b)(6)
13. MODE: A
1. 18. AJTF.ORITY #: 0363AOI5 2. rAq: 3. PRECEDENCE: R
4. STAT: All 5. GRADE: E03 6. ABE: 21Y 7. SO : M B. WT: 160 9. READY DATE- 363
10. ISO: 11. POR.- 12. SPEC CAT:
14. REAS REB- DS 15. DATE LAST VISIT: 16. CLASS: 2B
17. @T PHYS: JKRO 19. APPT/SURB DATE-. N3
20. APPRGV AUTH- 21. CP441@/INC: 22. VALID: JMC Y3
23. MU ORIS: A5150 LraA DI Y DPA@14 24. ICAD DRIG: MM
25. KW DEST: A5100 6 ACH 26. ICAU DEST: EDD.4
27. VO SPEC 1. SM 28. DIAS 1: 80841 CLOSO FRA@MI.ZE CF ILIUM
29. M-3 SPEC 2: 30. DIAS 2.
31. MB SM 3- 32. DIAS 3:
32A. PRCCEELIRE:
33. SPEC DIET: M/ 34. IV:
NG TUBE: N 38. RESP-. N 39. FOLEY: N 40. STRYKER.- N
41. INM.- N 42. TRACT: N 43. M: N 44. CAST/LDC: N 43. TRACH: N 46. r.04: N
71. PT BAG TYPE: NB 72. PT BAB TAG 73. PT BAG WT:
'7. SLIPP IK'DI
- FT. BRASS, N-. @PILIDATED BY JMRO/CLI.+* REPORTED BY
44TH MED/PT FROM 47 CSH
48. tlAX EXQTE STOPS-, Y / 9 49. ?'AX # RCNS-. Y 9 50. ALT REST/MAX KT: N
53. WATIENT: Y 54. SPEC PROS: VA D.RW ALCOH(P- WT tic.%,E x 55. VA CDDE-
Z6. AD.IINI
@g. VITAL SIGNS(TEMP/P'03VREEP/BLOOD PRESS): 098.6 60 16 1 120 74
59. HGB: 60. HCT-. 61. ABST DATE TAKEN:
62. WBC: 63. SI/YSI: 64. IOICATIC.'GE TYLENOL , 1-2 TABS PO a 4 PAS
65. HISTORY: FRAS 1.4JLRY 12 DEC 90. N3 I DO-IINAL INJLRY. RW ILLIAC WI
.,O FRA.MURED. PT REGUIRES (INGOINS WOL.9 CARE, L@IVE PT P44D 3-4 MO.NRH REC
GVF-RY. REMFMED OUT OF THE A3R.
66. ATT PHYS: D3WLS 67. PHt: 000 000 0000 68. WARD#/PH#: 000 / 000 000 0000
69. REPORTED BY: EST F.ARCa4T 70. PHt: 000 0000
74. ATTENDPLW NAM #I: 75. STATLIS: 76. SME,
77. ABE: 78. SEX@. 78A. WT: 79. RELATIONSHIP TO PATIENT:
80. BAB TYPE: 81. BAB TAB 82. BAB WT:
83. A Nk@ 42: 84. STATUS: 85. GRADET
86. ABE: 87. SEX: 87A. WT. BB. RELATIG.I&IP TO PATIENT:
89. BAG TYPE: 90. BAB TAB 91. BAB WT:
92. TRA@,S ORIS PHO%-T t. EXT:
93. TRANS DEST PHOKE 1: EXT:
94. ETA CRIS KrF(DATE/TlliE): ODO 95. ETA DEST MTF(DATEtTIME): 000
97. OTHER CO.VDAS:
5!. @SN #: 0000/30 52. ROI L(r.:
57. VALIDATED BY/REAS FOR fil@ZR PRECEDENCE:
96. AIRCRAFT ITINERARY:
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Document 31 f:/Week-31/BX000460/MEDSTAT- SITREPS - JANUARY - 1/personal data privacy act of 1974 4 jan 91:09209615580712
Control Fields 17
File Room = aug96_declassified
File Cabinet = Week-31
Box ID = BX000460
Unit = ARCENT
Parent Organization = CENTCOM
Folder Title = MEDSTAT- SITREPS - JANUARY - 1
Folder Seq # = 2
Subject = PERSONAL DATA PRIVACY ACT OF 1974 4 JAN 91
Document Seq # = 12
Document Date =
Scan Date =
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 = 20-SEP-1996