PATIENT FILE 29 OCT 90

File: 102896_aug96_decls1_0010.txt
Page: 0010
Total Pages: 46

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!34                                           **** PATIENT FILE ****                                           10/29/9,1
                                                      PERSONAL DATA - PRIVACY ACT OF i974



                                                                                                                           13. j@'iDDF: A
         1. NAME                                                18. AUTHCRITY 4@: 0297AO44 2. SSAN:                        3.  PRECEDENCE: R
         4. STAT: Ali              5. GRADE: E03                6. ACc@-. 25Y        7. SEX:            B. WT:    220      9.  READY DATE@ 299
         10@ ISO:                  11. POR:                                                                                12. SPEC CAT@
         14@ RE.AS REu'@ DS        15. DATE LAST VISIT:                                                                    16. CLASS: 2B
         17. ACCEPT PHYS:      JMRO                                 5 U.S.C. 552 (b)(6)                                    19. APPTISURG DATE: NO
         20, APPROV AUTH:                                                            21, @@ANC/TNC.-                       22. VAI@lDi                 LMK     Y7
         23. FITF BRIG: A3150      USA DISPENSARY DHAHRAN                                                                  24@ ICAO ORIG:       GEDR
         I mTF DEST; A@1030        FRANKFURT ARMY REG M'aD
         @5.                                                                                                               26. ICAO DEST:       EDAF
         27. rED SPEC I,. SOO      28. DTP.G 1. 9597     DiF@--,R AND UNSPECIFIED INJURY TO       ELBOW, FOREARM, AND l@4R     TST
         29. TIED SPEC 2:          30. DIA.G 2:
           Ili@D SPEC 3:           32. DIAG 3:
         32A. PROCEDURE;
         3 .SPEC DIET,    N/                                                         34. IV:
         39. FOLEY:            N   40. STRYKER@ N'
         41. T%,'@@'UB:N           42. TRACT: N          43.    TIMED: N             44. CASTILOC: N                  45. TRA'u'H:          N   46. i@ON: N
         71. PT BAG TYPE: NE                             72.    PT BAG tAG                                            73. PT BAS WT:
         47@ SUPP INFO: D CO       IOIST ABNI, FT CAMPBELL, KY                                                REPORTED BY
         354 4-iH. ****DS*@.**
         48. 'IAX ENIRTE STOPS- Y / 9                    49. MAX ii ROi'4S: Y        9                                50. ALT REST/MAX HTi N'
           TNPATIENTT N            54, SPEC PROS:     VA        DRUG     ALCOHOL      'AT     NONE X                  55. VA CODE:
         ,Z.I
         56.A i4I.-@/OVERSEAS:
           AD
         58. VITAL SIt-31@IS(TEMPIPULSE/Rclslo/DLOOD PRESS)
         59. PGB:                  60. HOT:              61. ABO@                                       DATE T KEN:
                                                                                                              .A
         62. NBC:                  63. SI/VSI-.          64. MEDICATIONS: TYLENOL QID PO




                                                                                     1
         65. 41STORY: TH@DO@INI    FRO@ TRUCK 24 OCT 90 AND SUSTAINED r,,U'-@IPLE BOUSES AND CONTU
         SION PLUS WRIST INJURY. REQUIRES FURTHER clv.ALUViION AND POSSIBLE SURGERY








         66, ATT PHYO@& DR. SILVER            67. PH#: 0013 000 0000                                 68.  6'P.RD#/PH#- 000 / 000 000 0000
         @9. REPORTED BY: GUIDO                                                                      70.  PH#: 000 0000
         14. ATTENDANT NAME #1@                                                                      75.  STATUS:                           76. GRADE:
         77@ AGE-                             78. SEX:                   78A. WT@                    79.  RELATIONSHIP to PATIENT:
                       81. BAG TAG                                            82.  BAG W-T%
         63. ATTENIDANt.T NAME 42:                                                                   84.  STATUS:                           95@ GRADE:
         96, AGE:                             67. SEX:                   87A@ WT:                    86.  RELATIONSHIP G PATIENT:
         99. BAG T P                          90. PAS TAG #i                                         91.  BAG WT:
                .Y@ E
         ?2z TRANS DRIB PHONE 4:                      EXT:
         971. TRANS DEST PHONE #@                     EXT:
         94. ETA ORIG IMTF(DAT /Tli@tE); 000 1                                                       95.  ETA DEST ilt@(n Tc@/Tji@c): 000
                               @E                                                                                       r mA
         97. OTHER COMMENTS:



         51. 41giN #: 41231299                                                                       52. RON LOC:
         57. VALIDATED BY/REAS FOR HIGHER PRECEDENCE:
         96. AIRCRAFT ITINERARY;

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