Document Page: First | Prev | Next | All | Image | This Release | Search
File: 092496_aug96_decls4_0031.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
16:21:18 PATIENT FILE 01/04/91
PERM-MAL DATA - PRIVAF.T ACT OF 1974
5 U.S.C. 552 (b)(6)
13. MODE: A
18. AUR@R
W.E., ITY #. 1002AOOB 2. MAN 3. PRECMCE-. R
4. STAT: All 5. MEi E06 6. ASE: 26Y 7. SEX; M S. @'T. 178 9. RWY DATE. 2
10. ISO: 11. POR-. 12. SPEC CATs
14. REAS RES: DS 15. DATE LAST VISIT: 16. CLASS: 3A
17. ACCEPT PHYS: Mg 19. AFFT/SURS DATE: NO
20. APPROV AUTH: 21. rANC/INCs 22. VALID: LMK Y3
23. MTF CRIS: A5150 LSA DI Y DHAHRAN 24. ICAD 0,RIG: OUR
25. MT DEST,. A5100 Mi 6 ADi 26. ICAD DEST: EDDN
27. PS SPEC I., SDO 28. DIAG 1: SW ROTATCR CUFF (CA%V.E) MIN
29. @@.ED SPEC 2: 30. DIAS 2:
31. PO SPEC 3: 32. DIAS 3:
32A. PROCED@'RE:
34. IV.-
35. 02/LPH: N 36. SLCT: N 37. NG TUBET N 38. RESP. N 39. F(P.XY: N 40. STRYKER: N
41. INMB: N 42. TRACR: N 43. IPS.- N 44. CAST/LGC: N 45. TRACH: N 46. MCN. N
71. PT R48 TYPE: MD 72. PT MS TAB 73. PT BAB WT.-
47. SUPP INFO: *HD-TSERT SHI 28 CSH
49. rAX ERM STCPS: Y / 9 49. MAX # RCIS- Y / 9 50. ALT REST/FAX HT: N
53. INPATIENT: Y 54. SPEC PRGG: VA DRLr3 AL@ WT NO'IE x 55. VA CODEs
56. AD,41N/OVERSEAS:
58. VITAL SIG%S(TErP/PLOMRESP/FAD PRESS): 098.0 60 / 12 122 86
59. HOD: bo. HU: 61. ADS.- I /DATE TAKEN.
62. WBC: 63. SI/VSI: 64. VZDICATICNS.- t@@
65. HISTORY: IYR HX CF RIGHT SHOLUER PAIN, CAUSEF BY LIFTING
66. ATT PHYS.- STD;vEi b7. PHO: 000 000 0000 68. WARD#/Pii#. 000 / 000 MO 0000
69. REPCRTED BY- SET MM4T 70. PH#: 000 0000
74. ATrMP44T NAIE #I: 75. STATUS: 76. GRADE:
77. AGE- 78. SEX: 78A. WT: 79. RELATICOUP M PATIENT:
EO. BAB TYPE: St. BAG TAB 82. SAS WT.
94. STATLIS: 85. ME:
86. AGE: 87. SEXI 97A. WT: 88. RELATICIZHIP M PATTENTI
89. BAB TYPE: 90. BAB TAB 91. BAB WT.
92. TRMS BRIG PHO%L EXT:
93. TRANS DEST PHCN@E EXT:
94. ErA CRIS MF(DATE/TIME): 000 1 95. ETA DEST MF(DATE/TitE): 000 1
97. OTHER COWOM:
51. 11,SN #, 52. Fr,.l LCC.
57. VALIDATED BY/REAS FOR HIC+.M PRECEDENCE:
96, AIRCRAFT ITIWMY: 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