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File: 102896_aug96_decls1_0009.txt
Subject: PATIENT FILE 29 OCT 90
Box ID: BX000482
Unit: ARCENT
Parent Organization: CENTCOM
Folder Title: MEDSTAT - SITREPS OCT 90 3 OF 4
Folder SEQ #: 16
Document Number: 10
06:49:19 **** PATIENT **** 10/@19/90
PERSONAL DATA - PRIVACY ACT OF 1974
I'@. VOLC@ A
1. 18. AUTHORITY #t 0299AO46 2. SEAN: 3. PRECEDENCE@ R
A
4, STAT: All 5. GRADE: E04 6. AS--- 92Y 7@ SEX: ri B. WT: 155 9. READY DATE; '499
10. ISO@ li. POR: 12. SPEC CAT:
14@ R@CAS RES: DS 15. DATE LAST VISIT: 16. CLASS, 3A
17. ACCEPT PHYS: T@IRG 5 U.S.C. 552 (b)(6) 19. APPT ''BURG DPTE@ NO
APPROV AUTP,: ')2. VALI
40 21. @@A@NC/INC; D: LMK Y7
23. @@'iTr' ORIS: A5L50 USA DISPENSARY DHAHRAN '@4. ICAO GRIG: OC@DR
26. ICAD DEST: EDAF
27. @,ED SPEC 1: SOO 28. DIAG 1. 6310'L 'CLOSED ANTERIOR DISLOCATION OF HUMERUS
29. @ED SPEC 2: '@0, DIAS 2:
31@ riED SPEC 7-i 32. DIAS
'2A. PROCEDURE;
33. SPEC D 7ET- NI 'V@
,4i
35@ 02/LPiM: N 36@ SUCT: N' 37, NS TUBE: N 719. RESP, N @,9. FOLEY: N 40. STRYKER@ N
41. l@,ICUE: N 42. TRACT: N 43. IMED: N 44. CAS-II/LOC: N 45. TRACH: @l 46. imON: N
71. PT BAB TYPET %B 72. PT BAG TAG f- 77.. PT BAB WT:
47. SUPP INFO: Fl. tl,-CPHEARSON', GA REPORTED BY
56TH ATH ****DS***
48. MAX FIN@RTE STOPS; Y 1 9 49. MAX # RONS: Y 9 @@o. ALT Rc,ST/iMAX HI: iN
53. I\!PATlEi%,'T@ i\l 54, SPEC PROO: VA DR,'JC ALCOHOL Jil NONE X 55. VA CODE:
..T
';6. ADMI.N/OVERSEAS:
58. VITAL SIONS(TEM.P/PULSEIRESP/BLE'DD PRESS):
59@ FSB2 60, HCT@ 61. ABC: I DATE TAKEN.,
IN 600 ?16 PRi%',, TYLENOL 3 1-2 TA
BS fa' 4 @'R
65. HISTORY: FIRS-] DISLOCATED L SHOULDER 18 OCT 71), HAVING REOCCURING PAIN AND
Liri7LTATION' OF M.BVE@NENT. POTENTIAL FCR PROLONGED RC,HABIL T7,ATION.
66@ ATT Ph'YS! D@R@ GRIGGS 67. 000 OOAI 0000 68. WAqD#/PH#- 000 / 000 000 000
69@ REPORTED BY: GUIDO 70. PH#@@ 000 0000
I EN'
ATT DA.\'T NAME 75. STATUS: 76. GRADE:
77. ACE: 78. SEX: ISA. WT: 79. RELATI iM' HIP TO PATIENT:
80, BAB TYPE: 81. BAG TAG 82, BAB VIT:
83. ATTENDANT NAME #2. 84. STATUS: 85. CRADE:
36. AGE, 87. SEX: 87A. WT. 88. RELATIONSHIP 10 PATIENT:
B9. lArz' TYPE: 90. BAG TAG 91. BAB WT:
94@@ tRAi\'S DRIG PHONE EXTI
73. TRANS DEST PH@NT- EXT:
?4@ ETA CRIC ITF@DATcl/TIMF); 000 95. ETA DEST iNITF(DATE/Tl@I.E): 000
97, OTHER COMMENTS:
51. MSti #: 4123/297 52. RON LOC-.
57. VALIDA T D BY/REAS FOD HISU R PRECEDENCE:
,E
T
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Document 46 f:/Week-32/BX000482/MEDSTAT - SITREPS OCT 90 3 OF 4/patient file 29 oct 90:10019616503417
Control Fields 17
File Room = aug96_declassified
File Cabinet = Week-32
Box ID = BX000482
Unit = ARCENT
Parent Organization = CENTCOM
Folder Title = MEDSTAT - SITREPS OCT 90 3 OF 4
Folder Seq # = 16
Subject = PATIENT FILE 29 OCT 90
Document Seq # = 10
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 = 01-OCT-1996