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File: 092496_aug96_decls4_0029.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
*w PATIENT FILE 01/04/91
KMI;AL@ DATA - PRIVACY ACT CF 1774
5 U.S.C. 552 (b)(6) 13. ?.ODE: A
art: 18. AUTHORITY #: 1002AO30 2. SSAN2@ 3. PRECEDEK'I-. R
4. STAT: Al I S. SWE.- EOS 6. ABE. 34Y 7. SEX.- F B. @'T: 110 9. READY DATE: I
.0. ISO: 11. POR: 12. SPEC CAT:
14. REAS L76: DS 15. DATE LAST VISIT: 16. CLM: 3A
17. @T PHYS: JKRO 19. APPT/SURB DATE: NO
20. APPROV AUTH: 21. CA.%C/IN:: 22. VLIID: CDH Y3
23. MTF DRIS: A5150 USA DISPENSARY DRk4.qAN 24. ICA3 DRIG-. M
2-. MTF DEST: A5030 FRA.@, T AR,'ff RES IS 26. ICAD DEST: EDAC
27, ?B SPEC I.* SE 28. DIAS 1: 2393 IE@ OF LNPECIFIED X4TIM OF BREAST
29. rg SPEC 2- 30. DIAG 2:
3'.. MED SPEC 3: 32. DIAS 3:
52A. PROCEDURE:
33. SPEC DIET: 141 34. IV: 1
35. 02/LPM: N 36. @'T: N 37. NG TUBE- N 38. RESP: N 39. FCLEY: N 40. STRYKER: N
41. INCIJB.- N42. TRACT: N 43. IND: N 44. CASTILCC: N 1 45. TRACH: N 46. MCN-. N
72. PT BAB TAB 73. PT BAB WT-
47. SLPP I.Vg,. 28 CSH FT BRASS NC PNT AT 28 CS
H
48. PAX E?ATE STCPS. Y / 9 49. MAX # RCNS: Y / 9 50. ALT REST/MAX HT: N
53. IWATIENT: Y 54. SPEC PROS: VA DRUG ALMKIL WT KM X 55. VA CGDE:
56. ADIIN/O@.ffi:
53. VITAL SIGNS(TEKO/PLLSE/RESP/B@GOD PRESS): 098.0 60 / 12 / 122 1 86
59. M: 60, )r.T. 61. ABBs / DATE TAKEN:
62. WB@.: 63. SI/VSI. 64. ?SICATIC?S- NONE
65. HISTORY: I YR HIST CF RI SP.01,UER PAIN CAUSED BY LIFTINS ACTIYITIES.
bb. ATT PWS: )IAJ STM@ b7. PH#: 000 000 0000 bg. WARD#/PH#.@ 000 / 000 000 0000
69. @LM BY: TSGT ROBI?W 70. PH#: 000 0000
74. ArrMA14T NA?F- #I, 75. STATL'Ss 76. G.WE:
77. AF@t 78. SEX: 78A. WT: 79. RELATIC.@P TO PATIENT-
83. BAB TYPE-. 81. BAB TAB 82. BAG WT:
83. ATrENDA'ff NAME 02.- 84. STATI:S. 85. GRADE-
85. ABE: 87. SEX: 87A. WT: 88. RELATIC.@P TO PATIENT:
69. EN TYPE.- 90. MS TAB 91. BAB WT.
92. TRANS ORIS PHONE r-XT:
93. TRA.XS DEST PHaqE 4: EXT:
94. ETA ORTS MTF(DATE/TIrt): 000 1 95. ETA DEST KTF(DATE/Tl?fE): 000
97. GM CGKRIMS:
51. YSN 1. 0000/001 52. Rr.4 LCC:
57. V;'LIDATED BY/REAS FOR HIGHER PFTECUENCE:
96. AIRCRACT ITINERARY:
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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