Document Page: First | Prev | Next | All | Image | This Release | Search
File: 092496_aug96_decls4_0020.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
16:18:26 PATIENT FILE Ho 01/04/91
DATA - PRIVACY ACT 0: 1974
5 U.S.C. 552 (b)(6)
13. MODE1 A
1. Kkl: 18. MMRITY #o 1002AO56 2. rA4 3. PRECEDENCE-. R
4. STAT- All S. PAE: EOS 6. AGE: 26Y 7. SEX- M S. WT: ]BO 9. READY DATE.- I
10, ISO: 11. POR: 12. SPEC CAT.,
14. REAS RES: DS 15. DATE LAST VISIT. 16. CM: 2B
17. AMEPT PHYS,. lq. APPT/SbRG DATE- M
20. APPROV AUTH-. 21. CkNC/IN@@: 22. VA, ID: ac Y3
23. MTF GRIS: ASISO LTBA DISPENSARY DPA@ 24. ICAD DRIS: OSR
25. IFTF DEST: F5070 USAFRI@C WESBADEN Gc. 26. ICAO DEST: OAF
27. Ya SPEC 1: j",O 2B. DIAS I.- 7242 LLPOM
29. @ SPEC 2: 30. DIAS 2:
31. PED SPEC 3: 32. DIAS 3:
32A. PRDCME-.
33. SPEC O[Er: W 34. IV:
37. NS TUBE: N 38. RESP: N 39. FMU,. N 40. N
41. INMB: N 42. TRACT: N 43. ItB: N 44. CASTILOC: N 45. TRADI: N 46. rON: N
71. PT BAB TYPE. NB 72. PT NS TAB I.- 73. PT BAB WT-
47. SLIPP TIED: 281 TRA.NS ///173 MBII
/ ///85 EVAV///
48. KAX EXRM STEPS: Y / 9 49. rAX # RM.- Y 9 50. A'@T REST/F.AX HT: N
53. IMPATIENT: Y 54. SPEC PROS: VA DRUG PL@ WT NGN'E X 55. VA CODE-
45. ADMIN/GVERVA:
58. VITAL SIGNS(TEMP/PLrMRESP/BLOOD PRESS): 098.8 78 14 t 128 78
59. HB.- 60. KT: 61. ABB: I DATE TAKEI:
62. WBC.- 63. SI/VSI: 64. MBICATI(INS. TYLEM@ 3 PO 3-4 HR PRN
65. HISTORY: 2 YR HX LEP - WCRSE SINCE DEPLDB - NO FIUING - BUT NOT RESR@IMIN
3 '-0 TREAM4 - EVAL REWIRED.
66, ATT PHYS. SMITH 67. PHI: 000 000 DOW 68. WARD.AIPH#. 000 / 000 000 0000
69. @TED BY: 70. PHI: 000 0000
74. ATTENDA'ff #I: 75. STATUS: 76. 6,RADE:
77. AGET 7B. SEX: 78A. WT: 79. RELATIO@P M PATIENT:
80. BAB TYPE: 81. BAB TAB 82. BAB WTt
B3. ATMMPLNT NAM t2. 84. STATUS. 85. GRADE:
26. AraE: 87. SEX: 87A. W'T: 88. RELATICNSIIIP TO PATIW,
S9. BAB TYPE: 90. BAB TAB 91. BAB VT:
?2. TRANS DRIG PPO%'c- EXT:
93. TRAKS DEST FF.X- t: EXT:
94. ETA ORIS MV(DATEffIrz): 000 95. ETA DEST KTF(DATEfTIME): 000
97. OTHER CGVMS.-
fi. MSq #: OOM/001 52. RC,.V LC@'.
57. VALIDATED BY/REAS FCR HI@ PRECEDDU:
96. AIR@ ITINERARY: I
Document Page: First | Prev | Next | All | Image | This Release | Search
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