Document Page: First | Prev | Next | All | Image | This Release | Search
File: 092496_aug96_decls4_0030.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
16:20:59 PATIENT FILE 01/04/91
PERSO\'AL DATA - PRIVACY ACT DF 1974
5 U.S.C. 552 (b)(6) 13. MODE: A
1. NWE-. 18. AUTHDRITY 1: 1003018 2. Mk4:mm 3. PRECEDENCE: R
4. STAT.- All 5. ME.- E06 6. ABE: 33Y 7. S@'X.- ?I B. WT: 185 9. READY DATE: 2
10. ISO: 11. POR: 12. SPEC CAT:
14. REAS REG: 03 15. DATE LAST VISIT: 16. CLASS-. 3A
17. ACCEPT PHYS: JMO 19. kl'FT/SL'RS DATE: NO
20. AOPRGY AgH- 21. CV@/INC: 22. VALID: TJJ Y3
23. KrF CRIS: A5150 USA DISPENSARY DHWA4 24. ICAD ORIS: OEDR
25. NW DEST: A5030 FRA.\ITLIRT ikRMY RES 10 26. ICAD DEST: EDAF
27. M SPEC 1: ?M 28. DIAS I.- 49390 @IM, LMMIFIED TYPE, STATLIS AMWATICLIS NOT MENTICHED
29. NED SPEC 2: 30. DIAS 2.
31. NED SPEC 3: 32. DIAS 3:
32A. PROCEDLRE.
33. SPEC DIET: U/ 34. IV:
ESP- N 39. F@: N 40. SRYKER: N
41. IhW: N 42. TRACT- N 43. IMED: N 44. CAST/LOC: N 45. TRADI.- N 46. MC%'-. N
71, PT BAB TYPE: la 72. PT PM TAB 0: 73. PT EM WT.,
47. SUOP IWO: DLITY STATIDN:28.'AS4 Fr BMSS REPORTED FROM. 28 CASH
48. MAX EKRTE STGN: Y / 9 49. MAX # RC.%: Y 9 50. AI.T REST/r.AX HT: N
53. INPATIENT: Y 54. SPEC PROS: VA DRUB AL-CCWL WT NOW- X 55. VA CODE.
56. ADIIN/
58. VITAL SIGNS(TEP/PULSE/RESP/BLOM PRESS): 097.0 90 16 / 130 90
59. JIBB: 60. HET: bl. ADS.- DATE TAM:
62. WECs 63. SI/VSI: 64. F.EDICATIO49. PRUWAL 2PLrFS 94, PRED.4ISM 60M
6 DAILY, THEOD@R 30OKS TID
&@. HISTORY: 4YR HX CF @.A N' W W/*EEZING A.10 SH.@ OF BREATH, SECONDARY
TC "UUST AND COLD. REGUIRES EVPL@ LQIT OF ADR. MULD NOT USE PROTECTIVE RASK IN
EvEh'T OF DOICA,. BjMBI,%S.
bb. ATT PHYS: &W.10 b7. PHt: 000 000 0000 bS. WA.RDI/PHO: 000 / 000 000 0000
69. REPCKM BY: ABBOTT 70. PH.I: 000 0000
74. ATTM4T KW II.* 75. STATUS: 76. SME:
77. AGE-. 78. SEX: 78A. WT- 79. RELATID.OZHIP M PATIENT:
82. BAB WT:
83. ATTDIDANT NW #2: 84. STATUS: 85. WME:
86. AGE. 87. SEX-. 97A. WT: 88. @TIONSHIP TO PATIENT:
89. BAB TYPE.- 90. BAB TAG 0: 91. BAG WT:
92. TRANS DRIS PP.OKE EXT:
93. TR(LNS DEST PHOIZ EXT:
94. ETA ORIS MTF(DATEtTIrm): 000 95. ETA DEST KTF(DATE/TlrE): 000 1
97. G@
51. MSM #: 52. RaN LCC.
57. VA!.IDATED BY/REAS FCR H16HER PRECEDENCE:
96. AIRCRAFT ITIN-@Y: I 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