PERSONAL DATA PRIVACY ACT OF 1974 4 JAN 91

File: 092496_aug96_decls4_0026.txt
Page: 0026
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








                 16-19i54                                          PATIENT FILE                                         01/04/91
                                                     PMIX DATA - PRIVACY ACT CF 1974

                                                            5 U.S.C. 552 (b)(6)
                                                                                                                   13.  rOE., A
           1. ?A@                                           18, AUTF.CRITY #: 1002AO74 2. rAI4.                    3.   PRECEDENCET R
           4. STAT: All            5. GRADET E04            6. AGE: 23Y          7. SEX: M          B. 6T:  170    9.   READY DATE:      2
           10. ISO:                11. PCR:                                                                        12.  WE CAT:
           14. REAS REG,. DS       15. DATE LAST VISIT:                                                            16.  CLASS: 3A
           '7. ACCEPT PHYS:
                                                                                                                   19.  APPT/SL'RG DATE: NO
           20. APPROY AUTH.-                                                 21. CANI.IINC-                        22.  VALID:               JKC 1 Y5
           23. KTF BRIG, A5150     USA DISPENSARY DPAM                                                             24.  ICA3 CRIS:    CEDR
           25. MU DEST: F5M LISAFRMC WIESBADEN GE                                                                  26.  ICAD DEST:    DV-
           27. YED SPEC 1. SSE     28. DIAS 1. 55329 HMIA, OTHER
           2?. .18 SPEC 2:         30. DIAS 2:
           31. PS SPEC 3i          32. DIAG 3:
           32A. PRCCEDLRE:
           33. SPEC DIETs       NI                                           34. TV-
           35. DVLPH: N            36. SULT.-  N         37. 80 UK- N        38.  RESP: N                      39. FOLEY:      N      40. STRYKER: N
     44.  CAST/LGC: N                  45. TRACH:      N      46. ?.ON-. '.4
           71. PT RAG TYPE.     IZ                       72. PT BAB TAB    1:                                  73. PT BAB WT.-
           47. SUPP IWa. 2/502 HIE IOIST AB,       FT FA'TBELL, KY                                     //44 ?ED//
           //28 CSH//
           48. KAX LXRTE STOPS: Y / 9                    49. MX # RM-. Y         9                             50. ALT REST/KAX HI: N
           53. IKPATIENT-. Y       54. SPEC PRCG:    VA     DRJG      ALCOHOI@    VT     X04E X                55. VA CODE:
           55. ADMINIOVEFTSEAS-
           !B. VITA'- SIM(TEVP/PU'-SE/RESP/BLOOD PRESS): 098.0               65   12 /   125        70
           59. FGB.                60. MCI:              61. ABS.                        I    I DATE TAKE4:
           62. 'dBC:               63. SI/VSI:           64. MDICATIONS: MOTRIN BOOMS TID




           65. HISTORY: PATIENT MEFN'W SURGMY FC.R EPIGASTRIC P.MIA 04 26 DEC 90. ttED
           2-3 lf@ CON LEAVE








           66. ATT P;4YS. SIPPD                67, PHI. 999 9?9 99?9                          68.   WM)/pH#: 999 / 999 999 9999
           69.                  BY., SST ABBOTT                                               70,   PHI: 999 9999
           74. ATTENDANT ta'E St:                                                             75.   STATUS:                        76. GWEI
           77. AGE:                            78. SEX:                78A. WT:               79.   RELATIMMIP TO PATIENT:
           60. BAB TYPE:                       61. RAG TAG #t                                 82.   BAB KT-
           83. ATTENDANT        NAME 02:                                                      84.   STATUS:                        85. GRADE:
           E6. AG--:                           27. SEX:                87A. WT:               BB.   RBATIDWIP TO PATIENT:
           89. BAB TYPE.                       90. BAB TAB I.,                                91.   BAB WT:
       92. TRANS ORIG       PMLC 1:              EXT:
           93. TRANS DEST       PHX #-.              EXT:
           94. ETA CRIS MF(DATE/TIME): 000                                                    95.   ETA DEST KrF(DATEITIME): 000 1
           97. OTF.ER COMM:



           5:. 'EV #- DOOO/002                                                                52.   RON LOC-
           57. VALIDATED BY/FtEAS FOR HI M PRECEDDA.
           96. AIRCRACT 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