PERSONAL DATA PRIVACY ACT OF 1974 4 JAN 91

File: 092496_aug96_decls4_0021.txt
Page: 0021
Total Pages: 31

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








                     i6:18:41                                               PATIENT FILE                                               01/04/91
                                                                PERSDVXI DATA - PRIVACY ALT OF 1974
                                                                       5 U.S.C. 552 (b)(6)
                                                                                                                                  13.  MODE: A
                                                                   18. NRCR
                PAIE:                                                            M #: 1002AO50 2. MN:                             3.   PRECEDENCE: R
                4. STAT: A12              5. GRADE: EOS             6. AGE: 21Y          7. SEX: M             B. WT:     155     9.   READY DATE:         I
                10. ISO:                  11. POR:                                                                                12.  SPEC CAT:
                14. REAS REG,. DS         15. DATE LAST VISIT-                                                                    16.  CLASS: 2B
                ,7. ACCEPT PHYS,          MD                                                                                      19.  APPT/SLRB DATE: NO
                20. APPROV AUMT                                                        21. CILT6/lNr.:                            22.  VALID:                  imc    Y3
                23. KrF CRIS: A5150       USA DIS      Y DPA@4                                                                    24.  ICAD CRIS:     OEDR
                25. 1% DEST: F5070              WIESBADEN GE                                                                      26.  ICAO DEST:      EDAF
                27. KED SPEC 1: SM        28. DIAS 1. 733B2     NANIMCN OF FRAMIIE
                29. KED SPEC 2:           30. DIAS 2-.
                31. KM SPEC 3:            32. DIAS 3:
                32A. PROMU.@
      NI                                           34.   IV:
                35. 02/LPM: N             36. @17:   N          37. NS UK-. N          38.   REEP: N                         39.  FOLEY:       N     40. STRYKER: N
                41. INDJB:    N           42. TRACT: N          43. INED- N            44.   CAST/LGC: N                     45.  TRADit       N     46. tlOI: N
                71. PT BE TYPE., NO                             72. PT BAB TAB     t.                                        73.  PT PM WT:
                47. SLPP INr-0: 325M MAINT M LAKEVIEW           FL/// BM EVAC/l/


                48. VAX EKRX STWS- Y 1 9                        49. VAX # RONS: Y         9                                  50.  ALT RESTIFAX HT: N
                53. INPATIENT: Y          54. SPEC PROG:        VA  DRUB      ALCONCL        WT     KC.4E 1                  55.  VA CODE:
                56. ADMIN/
                @8. VITAI. SIGNS(TEMP/PLRMRESP/Bl@MD PRESS): 098.8                  96       2D /    96        66
                59. HED.-                 60. MT:               61. ABS.-                                      I DATE TAKEN:
                62. WBC:                  63. SI/VSI:           64. REI)ICATICIS: M3TRIN 40OKS TID




                65. HISTORYs RIGHT FOOT PAIN - CAST FOR CWFM, CAST CAM FURTHM PAIN
                F.A.@  17 DEC 90 AT M3TCR POOL CURORY NO CAST








                66. ATT P)IYS. MOM                   67.  P)i#- B74 5B7 4578                                   68. M#/P)41: 457 / M 784 5978
                59. REPCRTED BY: DREYER                                                                        70. PH#, 875 4454
                74. ATTENDANT NRE #I.                                                                          75. STATLIS:                       76. GRADE:
                77. AF-.                             78.  SEX:                 78A. WT:                        79. RELATIC.MP TO PATIENT:
B $:                                           82. BAG NT:
                B3. AnMlt\'T  NK #2-                                                                           84. STATUSI                        85. GRADE:
                86. AGE:                             87.  SEX:                 87A. WT.                        88. RELATIONSHIP TO PATIENT:
                09. BAB TYPE.-                       90.  BAS TAB                                              91. RAS WT,
                92. TRANS GRIG @@ 1:                            EXT:
                93. TRA.)S DEST PP.DM #:                        EXT-.
                94. ETA CRIS MTF(DATE/TIME): 000                                                               95. ETA DEST MU (DATE/TIME): 000
                97. OTF.ER M,@:



                51. ?1&4 #8 0000/001                                                                           52. RON LOC.
                57. VALIDATED BY/REAS FOR RIDO PRECEDea,
                96. AIRCRAFT  ITINERARY:

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