PATIENT FILE 29 OCT 90

File: 102896_aug96_decls1_0012.txt
Page: 0012
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



                                                             ****            Ft@' @c ****                                     1 0/@47/90
                                                     PERSONAL DAT - PRIVACY ACT OF 1974
                                                                  .A



                                                                                                                           13. riDDE: A
                                                                                                                           3. PREr@EDE@kiCEt R
                                                          '8. ALTHORlTv #: 0299AO60 2. SSAN: @
    4.    SIAT:  All               5. 1 AE: E04            6. AGE: 26Y          7. SEX@ M             B. WT2     190       9. READY DATE: 299
                                   BRAD
    10@   160:                     POR:                                                                                    12, SPEC CAT:
    14.   PEAS REG@ DS             5. DATE LAST VISIT:                                                                     16. CLASS: 2B
    17.   ACCEPT PPYS:       JVFRO                            5 U.S.C.       552 (b)(6)                                    19@ APPT/SURG DATE: NO
    40.   Ar'PROV AUTH:                                                         21@ P@ANIC/INC;                            22. VALID:                Lr@K    Y7
    2@@.  MTF 0016t A@-150         USA DISPENSARY DHAHRAN                                                                  24. ICAO CR!GI     DEDR
    2@-.  MTF DEST: A@@07-0        f:RANNFLI@RT AviY REG NED                                                               26. !CAD DEST:     EDAF
                                                @R
    27.   F@ED SPEC 1. SOO         28. DIAS I,. 71916  HERARTF@ROSIS INVOLVING LOWER LEG
    29.       SPEC 2@ SOO          30. DIAG 2: 8360    TEAR OF IMEDIAL CARTILAGE OR MENISCUS OF @@NEc', CURRENT
    31.   N-tD SPEC 3:             -,2. DIAS
    32A. PROCEDURE:
  33. SPEC DIET:       iN/                                                    34, IV:
    35. 02/LPi@: N'                36. SU'@T@   N-     37. NS TUBE: N'          38. RESP: N'                         39. FOLEYT           N   40. STRYKEP@: N
    41.   INCUB:         N         42. TRACT@ N        43. IRIE'U: N            44@ CAST/LOC: N                      45. TRACV,-.         N   46. M.OIN: N
    71.   PT BAG TYPE: NB                              72@ PT BAG TAG       4:                                       73, PT BAB    @IT:
    47@   SUPP INFO@ HHC FORI      STEWART, 'OA                                                            REPORTED BY
    28 CSH ***DS***
    'g@   @@'IAX c,NRTc ST PS: Y     9
                         @ O                           49. i4AX # RONS: Y          9                                 50@ ALT R'CET/@IAX HT: N
    5 .   'NP@'IEI%,T,
          I   i          N'        54. EFEC PRO'C@   VA     DRUG       Al@c@'OL     WT      NONE X                   5@ VA CODE:
    56.   ADriLN/DVERSEAS:
    56,   VITAL SICNS(Tc,MPIPULqE/REEP/-'@LOOD PRESS).
    59.   P.CN                     60. HCT:            61. ADS:                                       DATE T.A'(EN:
    ,@2@  lk'BC:                   6'@. SI/VSI:        64. M'CDICATIONS: NONE




    65.   HISTORY: INJURY          TO LEFT KN---E WITH ACUTE HEMATHOSTO










    66,   ATT PHYS: ABIECILLO                   67. PH@#: 000 000 0000                             68. 'AARD@/PH*: 000 / 000 000 0000
    69.   REPORTED BY: GUIDO                                                                       70. Pu#: 000 0000
    74.   ATTENDANT NAi-iE #I.                                                                     75. StA71ds:                           76. GRADE:
                                                                                                                     Tp
    77.   AGE:                                  78@ Sclx:              78A. @'T@                   79. RELATIG'JCH@ -10 PATIENT;
                  81. BAB TAG                                        82. BAG WT:
    8@    ATTENDANT      NIAti@C #'@z                                                              84. STATUS:                            85. GRADE:
    96,   AGE!                                  87. Sc@X:              67A. 1,@,T:                 88. RELATIONSHIP TO PAtIc,NT:
    89@   BAB TYPE:                             90. DAG TAG 4:                                     91. BAG WT:
    9-1@  TRANS ORIG PHONE                           c@XT:
    93.   TRANS DEST PHONE                           EXT!
    94.   ETA ORIG MTF(TIATcl/Tljy,@E)@ 000                                                        9@@. ETA DEST MTF(DATE/TIM.E)i 000
    97.   OTHER COr.,rEKS,,



    5i.   XiSN #: 4123/299                                                                         52@ RON L04';
    57.   VA'@IDAT D BY/REAS @ R HIGHER PRECEDEN'p@E:
                  .E               ro
    96.   AIRP@RAFT ITINERARY@
          11

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