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File: 092496_aug96_decls4_0015.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
.6:17:04 PATIENT FILE ftiw* 01/04/91
PERSCVAL DATA - PRIVACY ACT OF 1974
5 U.S.C. 552 (b)(6)
13. M3DE-. A
18. AUTHOR
ITY #t 0365AO36 2. SSPL,4: 3. PREMEK'CE' R
4. STAT: All 5. GRADE: E04 6. AGE: 22Y 7. SEX.- M S. WT: 203 9. READY DATE: 365
10. ISO: 11. POR: 12. SPEC CAT:
14. REAS AEG: DS 15. DATE LAST VISIT: 16. CLASS: 3A
17. A= PHYS: M 19. APPT/MRS DATE- NO
20. APPROV AUTH: 21. CA\C/IN:-. 22. VALID- SKF Y2
23. W ORIS: A5150 LSA DISPENSARY DHAWA%4 24. ICAD DRIG: CEDR
25. MV DEST: A5100 ACH 26. ICAO DEST,. EDIII
27. PED SPEC 1: SUB 28. DIAS 1: 71783 CLD DISRLtPTI(Lwl OF AWMIGR CRUCIATE LIGAMff
29. MB SPEC 2: 30. DIAS 2:
31, Va SPEC 3- 32. DIAG 3.
32A. PFMCEDLIRE:
34. IV: 1
35. 02/LPM: N 36. SLL-T. N 37. NS TUBE., N 38. RESP- N 39. FMD: N 40. STRYKER- N
41. INCIJB: N 42. TRACT: N 43. IKED.- N 44. CAST/LO@': N 45. TRACH: N 46. r.C.N. N
71. PT BAB TYPE: hB 72. PT BAG TAG 73. PT BAG WT:
47. SLPP IN'r-0: lfr. I AD ARCM BE ///FLEET 5///
46. MAX E)LRTE STOPS: Y 9 49. ?.AX I RIKIS: Y 9 50. PLT REST/YAX HT: N
53. INPATIENT: Y 54. SPEC PROS: VA CRUB ALCDHCL WT NONE X 55. VA CODE-
@6. ADMINIUMEAS:
@3. VITAL SIGNS(TEMP/PLFSE/RESP/BLOOD PRESS): 098.1 68 18 / 110 60
59. HGB: 60. HCT: 61. ABG- I DATE TO.KEN:
62. wr.: 63. SI/VSI: 64. MEDICATICNS: NC-.NE
65. HISTCRY: SIP RIGHT KQEE INJURT OCT 90 SIP SMPE 24 OrT 90 PATIENT
S,,RGERY RI,'3W KN-F A.4D POMIEU v.:B
66. Arr PHYS: NILKERS 67. PH#: 473 854 7384 68. @/PH#: 73B / 473 847 3843
69. REPORTED BY: DREYER 70. Phl-. 745 6475
74. ATTENDA4T W14E #I: 75. STATUS: 76. GRADE:
77. ABE. 78. SEX: 78A. hT: 79. RELATI MIP TO PATIENT:
80. BAB TYPEI 81. BAB TAG 82. BAB WT:
MA #2: 84. STATUS: 85. GRADE-.
a6. AGE. 87. SEX: 87A. WT: 88. RELATICOUP TO PATIENTT
69. BAG TYPE: 90. BAS TAG 91. BAG @'T:
92. TRjkNS CRIS PH3N'E EXT:
93. TRA%S DEST PHOKI EXT:
94. ETA ORIS MTF(DATE/Tlrt)t 000 95. ETA DEST M(DATE/TI?(E): 000
97. OTHS @S.
SI. NSIJ #: 0000/365 52. RCN LCC:
57. VALIDATED BY/REAS FOR HID'.ER PRECEDENCE:
9b. AIRCRP4q ITIKMY:
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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