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File: 102896_aug96_decls1_0011.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:Ls PATIEN] FILE 10129190
PERSONAL DAT - PRIVA@ ACT OF '974
A uy
13. RODE: A
1. 18. AUTHORITY #: 0299P,058 I.. SSAN: 3@ PRECEDc@N'P.E: D
4. S7 T: Al, 5. GRADE: P04 6. AGE: 25Y 7. SEX: r@ B. @4T: 198 9. READY DAJE: 299
io. !So: li@ POR-. 1'4. SPEC CAT:
14@ @REAS RES: DS DATE LAST VISIT: 16. CLASS: 2B
17. ACCEPT PHY@ J@IRD 5 U.S.C. 552 (b)(6) 19@ APPTISURG DATE: NO
20. APPROV AUTH@. 21. CAt'4C/IjN'u@ 22. VALIDI 1 M.@ Y7
23. MiF OR-IG: A@@150 USA DISPENSARY DHAHRAN 24@ ICAO ORIG: GEDP,
25. MTF DEST: A@@030 FRANKFURT ARMY REB DIED 26. ICAG DESTI E'DAF
27. NED SPEC 1: 500 28. DIAS 1: 8442 SPRAIN, OF CRIJCJ-.ATE LIGAMENT OF KNEE
29. FRED SPEC 2: 30. DIAS
'DIED SPEC -
I 6! '@2. DIAS
32A. PROCEDURE:
N/ 34. IV:
35. 02/'@p@lig N 36. Slj'P@T. N 37. NG TUBE: N 3B. RESP: N' 39. FDI-EY@ N' 40. STRYKER: N
41. IN@@'UB: N 42. TRACT: N 43. !MED: N 44. CAST/LOC: N 45. TRACH: iN 46. MON: N
71. PT BAB TYPE: NIB 72. PT BAG TAG 73. PT BAB WT:
47, SUPP INFO: HHC 20 EN6R 101 ABN FORT CAYIPBELL, REPORTED BY
28 CS'@A ****DS***
46. ,'IAX EN;RTC@ SIOP@ Y / 9 49. mAX # ROiNSt Y 1 9 Jo@ ALT REST/M@AX HT: N
5'@. INPATIENT: N' 54. SPEC PROS: VA DRUG ALCOHOL WI NONE X 55. VA CODE:
56. AD@MIN'OVc@RSEAS@
5& VITAL SIONG(TEMP/PULSE/RESP/BLOOD PRESS): I I
59. PGB: 60. HCT: 61. ABO: / DAF, TAKEN:
62, 'W'BC: 63. SI/VSI: 64. MEDICATIONS NONE REPORTED
65. HISTORY: TEISTED RIGHT KNEE A7, BEACH 4 AGO ... iNOTIC'cD A "POP". KNEC, I
S Si I LL UNc@:TALi c@
66@ ATT PL4.YS: APRIETC@ty 67. PH#: 000 000 0000 66. WA DO./Ph#: 000 / 000 000 00
@R .0
69. REPORTED BY: GUIDO 70, PP@#: 000 0000
AME #i@ 75. STATUS@ 76. GRADE:
77, AGE-@ 76. SEX: IBA. WT: 79. RELATIONSHIP TO PATIENT.-
80. BAG TYPE: 81. BAG TAB 82. GAS WI:
83. A I TENDPT%'T iNIAXtE #2i 84. STA I b'@ 85. GRADE:
86. AGE: 87, SEX: 67A. WT@ 88. RELATIONSHIP TO PATIENT:
69. BAG TYPE: 90. BAG TAB 91. BA7o '@4T:
92. TRANS ORIS PHONE F-XT:
93. TRANS DEST PHONE t@ EXT:
94. E7ORIG ITF(DATE/TDIE): 000 95. c A DEST MTF(DA'Z/TIMP-): 000
,A @T
97. OTHER COMMENTS.
51@ 411@3/299 32, RON LOC2
0
j7. VALIDATED DY/REA.6 c @R HIGHER PRECEDENCE:
96. AIRCRAFT ITINERARY: 11 11 I
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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