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File: 102896_aug96_decls1_0014.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
06t5Ot49 PAT TENT FILE 10129/90
I
PERSONAL DATA - PRIVACY ACT OF 1974
13. MDD'E: A
1. 18. AUTHORITY #: 0299AO54 2. SQAN 3. PRECEDENCE: R
4. SIAT; All 5. GRADE: E02 6. AGE: 22Y 7@ ScX; F S. t4T@ 132 9. READY DATE: 299
10. 190: 11. POR: 12. SPEC CAT:
14@ REAS REGI DS '5. DAIE LAST VISIT: 16. CLASS: 3A
17. ACCEPT PPYS: Ji'IRD 5 U.S.C. 552 (b)(6) 19. APPT/SURG DATE: NO
20. APPROV AUTH: 21. C'@@NC/INC: 22. VALID: f LMK@ Y7
2.-3. MTF ORIG: A5150 USA DISPENSARY DHAHRAN 24. '-CAD DRIG@ OEDR
25. MTF DEST@ A5030 FRANKFURT ARMY REG NED 26. ICAD Dc@Si: @-DAF
27. VFED SPEC 1: SGD 28. DIAS 1. V239 SUPERV"SIC," OF UNSPECIF TED PIGP.-RISK PREGNANCY
L9. YP-D SPEC 2: 30. DIAG 2:
PEC 3: 32. DIPS 3:
32A. PROCEDURE:
3Z. SPEC DIET: N/ 34. IV.
35. 0211@pr,: N' 36. SUCT: N 37. NG TUBE: N 38. REQP: N 39, FOLEY: N 40. STRYKER: N
41@ INCUQ: iN 4.. IRACT! jN 4'. IMED: N 44, CAST/LGC: N 45. TRACH: N 46. VON: N
71. PT BAB TYPE: ND 72. PT BAB ]AG 73. PT BAB @IT:
47@ SUr'P INFO: 494 TRANS FORT CPMPD'ELL, KY REPORTED BY
28 CSPI ***DS***
49. MAX ENRTE STCPS: Y / 9 49, MAX # RONS: Y 9 50. ALT Rc,ST/MAX HTi N
5'. INPATIENT: N 54. SPE' PROG: VA DRUB ALCOHOL '@,T NONE X 55. VA CODE:
56. A@uN.IN/GVERSEAS:
58. VITAL SICNS(TEMP/PULSc,/R'@SP/BLOOD PRc@ss): 098.6 / 84 20 / 118 78
59. HGB: 60. HCT: 61. ABB: I DATE TAKEN:
62. WBC: 63. SI/VSI: 64. MEDICATIONS: PRENATAL VITS
6@@@ HISTORY: ON BIRTH CONTROL PILLS X 6 MONTHS WHILE PRESNANT. NEED FULL WORKUP
TCHc K FOP FETAL ADiNORriALIT 7ES. PATIENT WAS NOT AWARE SHE WAS PREGNANT
io C 1
66. ATT PP@YS: DR SIPPO 67. PH#@ 000 000 00011 68. V.IARDt/PH#: 000 000 000 0000
70. Pu#: 000 0000
74. ATTENDANT NAME #I. 7i. STATUS: 76. GRADE:
77. AGE. 78. SEXT 78A. Wi: 79. RELATIONSHIP TO PATIENT:
80. BAB TYPE: B'@ BAB TAG 82, BAG 14T:
83. ATTENDANT NAME #2: 84, STATUS: 85. GRADE:
86@ AGE: 87. Sc@X: 87A. WT: 86. RELATIONSHIP TO PATIENT:
89. BAG TYPE: 90. BAG TAG 91. BAG WT.
'rz. TRANS ORIS PHONE EXi:
93. TRANS DEST PHONE FXT:
94. ETA. ORIG MTF(DATE/TIVE): 'VOO I 9z,. ETA DEST imTF(DATE/71MC): 000
97@ OTHER COF@riEi\'TS-.
5,. FISN e4@ 4123/299 52, RON LOC:
57. VALIDATED DY/REAS FOR HIGHER PRECEDENCE:
96. AIRCRAFT ITINERARY:
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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