PERSONAL DATA PRIVACY ACT OF 1974 4 JAN 91

File: 092496_aug96_decls4_0025.txt
Page: 0025
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








                    16:19*39                                              PATIENT FILE tomi                                          01/04/91
                                                           PEM'4AL DATA - PRIVACY ACT CF 1974

                                                                                         5 U.S.C. 552 (b)(6)
                                                                                                                                13.  KLME: A
                1. ME:                                             18. ALP.DRITY #. 1002AO73 2. SSk4:1=                         3.   PRECEDM- R
                4. STAT.-  All         5. GME; E04                 6. ABE: 22Y           7. SEX. n           S. WT:     179     9.   REOY DATE:         2
           10.  ISO:                   11. PCRI                                                                                 12.  SPEC CAT:
           14.  REAS RES:              DS 15. DATE LAST VISITI                                                                  16.  MM-. 3A
           17.  ACCEPT PHYS:                                                                                                    19.  APPT/SLES DATE.- NG
           20.  APFROY AU7H:                                                          21. CAN@./INC,.                           22.  YALIDs                 itc    Y5
           23.  KTF BRIG: A5150        USA DISPENSARY DKMN                                                                      24.  ICAO ORIS-     OEDR
           25.  W DEST: F5070          US".C WIESBADEN BE                                                                       26.  ICAD DEST:     aW
           27.  XB SPEC 1. SSE         28. DIAS 1: 55090       INGUIML WMIA NOS, LWILATERAL           OR MWCIFIED
           29.  MED SPEC 2:            30. DIAS 2:
           31.  Ps SPEC 3:             32. DIAS 3-.
           32A. PRDCEDURE:
           33. SPEC DIET:              N/                                              34. TY:
 35. 02/LPM: N               36. M.        N         37. Ng TUBE: N          38. RESP: N                         39.  FUZ:        N       40.             N
           41.  INCUB:                 N42. TRAr.T-. N         43. IMB. N              44. CAST/LOC.@ N                    45.  TRADI:      N      46. MO'i: N
           71.  PT BAB TYPE. AM                                72. PT BAB TAB                                              73.  PT HAS WT.-
           47.  SUPP I.*-D: HP.C 1/187 INIF, FT       WBELL,       KY                                             //44 MED//
           //2a csH//
           48.  KftX MTE STen: Y / 9                           49. PAX 0 ROHS:     Y     9                                 50.  LI I REST/MAX HT: N
           53.  lk?ATIENT: Y           54. SPEC PRCB:       VA     DRUG       ALCOHOL      WT     NONE X                   55.  YA CODE:
           56.  ADMIN/D
           58.  YITAI- SIM(TEMP/PLI.SE/RESP/FMD PRESS): 098.6                      80      IB /   108        76
           59.  HBO:                   60. NCT:                61. AM:                                       DATE TAKei:
           62.  WBC.-                  63. SI/YSI-             64. MEDICATI04S: TYLENOL #3        1-2 TABS PO 4-6 PqS FOR
           PAIN



           65. HISTCRY: PATIENT @ RECURRENT LEFT INSUINAL FMIA 29 DEC 90 FOR CC,4 LEAYE
           14-21 DAYS.








           66.  ATT PWS. BM                          67. PH#: 999 999 9999                              be.  MMIPHI: 999 / 99V 999 9999
           69.  REPORTED BY: L-ST ABBOTT                                                                70.  Pht: 997 9M
           74,  ATTMAff Nkf- #I:                                                                        73.  STATUS:                            76. GRAD----.
           77.  AGE:                                 78. SEX:                 78A. brr:                 79.  REI-ATIOMIP TO PATIENT.
        82.  BAB WT:
           BZ.  ATRMNT KKME #2:                                                                         84.  STATLIS:                           83. GM:
           86.  AjE:                                 97. SEX:                 97A. WT-                  88.  RELATIONSHIP M PATIENT:
           89.  BAG TYPE:                            90. BO TAB                                         91.  BM WT.-
           92.  TRKNS GRIS PHG?E 0:                        EXT:
           93.  TPANS DEST PruNE 0:                        EXT:
           94.  ETA BRIG KTF(DATEfTIME): 000                                                            95.  ETA DEST MTF(DATEITIME)I 000
           97.  @ER



           51.  vSN #.- 00001002                                                                        52.  RON LCCI
           57.  VALIDATED BY/REAS FC-R HiGhU PRECEDENCE:
           96.  AIRCRAFT ITINERARY:                      I

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