PATIENT FILE 29 OCT 90

File: 102896_aug96_decls1_0015.txt
Page: 0015
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@5i: 15                                                               PATIENT FILE                                                                10/29/9C@
                                                                         FERSOi\'A" DATA - PRIVACY ACI OF 1974



                                                                                                                                                             3. nDEi A
              l@ NAME                                                          16, AUTHORITY 'I: 0297P.O@@6 2. SSANI:                                             PRECEDENCE: R
              4, STAT@   All                    5. GRADE.                      6. AGE@ 20Y                  7. SEX@ .M               S. WT@         19,@     7.   READY DATE; 299
              io@ ISO:                          li@ POR-                                           11                                                        12,  SPEC CAT:
              14@ REAS RE@- DS                  15. DATE LAST VISI-I@                                                                                        16.  CLASS: 3A
              17. ACCEPT                                                          5 U.S.C.           552 (b)(6)                                              19.  APPT/SURG DATE: NO
              20@ APPROV AURIH:                                                                        21, PIANC/INC@                                        22.  VALID:                          LMK      Y7
              2@ NTF OR  TC@ A5130              USA DISPENSARY D-' HRAK!                                                                                     '@4. ICAO GRIG:           DEDR
                                                                         iA
              MTF DEST: A5030                   FRANKFURT ARMY REG       YIED                                                                                26.  ICAD DEBT:           EN@AF
 DIAS 1: 2673         PRIMARY TFRu'ViDOCI(TOPENIA
              29. @@c,D SPEC 'L;                30. BIAS 2:
              31. NED SPEC 3@                   32. DIA@R
              32A. PPOCEDURE@
              33. SPEC DIE[T          N/                                                                    4. IV-@
              35, 02/LPi'i: @' /                36. SLI@,I               37. NG TUBE: N                3&         R-TSF- 14                            19. FOLEY:                  N   40. STRYKER: N
              41. lt%'CUB:            N         42. TRACT: N             4 . IMED; i%'                 44.        CAST/LGC: i%'                        45. TRA@.HI                 iN  46@ riOiN: N
              71. PT BAB TYPE: NB                                        72. PT BAG TAG                                                                73. PT BAB @'T@
              47. SUPP INFO: ***DS***                                                                                                      REPORTED BY
              IPSPI
              Le1
              49. MAX ENRTE STOPS: Y            / 9                      49. MAX # RONS@ Y                  9                                          50. ALT RESTIMAX KT: %I 1
              53. INPATIENT: N'                 54. SPEC PROO@!          VA    DRUG          ALCOHOL              @'T   NONE X                         Si. VA CODE:
              56. ADMI@/DVERSEAS:
              56@ VITAL SIGNS         (T iMP/PULBr/Rc P/PLOOD PRESS)@ 097.6                          56           12 1  114          70
                                      @E        @ @s
              59. @4CT':                        60. HCT:                 61, ABS:                                                    DATE TAKEN:
              62. 14BC: 23000                   63. SI/VSL:              64. MEDICATIONS: PREDN                   TSONE 60 MG PO DAILY




              65, HISTORY: HX OF IDIOPATHIC THROMBOCYTOPEN'IC PURPERA










    67. PH#;           000 000 0000                                      68,    14ARD#/PH.@@: 000 / OOE) 000 OOA@O
              69. REPORTED BY: GUIDO                                                                                             70.    PP.#: 0        0000
              74. ATTENDANT NAME #I:                                                                                             75.    STATUS@                                    76.    GRADE:
              77. ASc@@                                     16, S--@X:                        78A. WT@                           79.    Rt-i@ATIn@N'@'IP TO PATIENT:
              30. GAS TYPE:                                 81. BAB TAG 'V:                                                      82.    DAB WT:
              8 .W, -i ENDA@N'T       NAME 2:                                                                                    84.    STA7iUS!                                   85.    GRADE:
              96. AGE:                                      87. SEX:                          B7A. !A-[:                         88.    RELATIONSHIP TO PATIENT:
              87. BAD 1-YFE;                                90@ BAG      iAG 1:                                                  91.    BAB 'AT:
              9@L. IRANS ORIG PHONE 4:                                   EXT:
              93. TRANS DEST PHONE #:                                    EXT:
              94. ETA CRIG MTF(DATEITIFiE)-. 000 1                                                                               95.    ETA DEST %ITF(DATE/TIME): 000
              97. OTHER COMMENT S:



              51@ *,SN #z 4ILn3/299                                                                                              52. RQ,\' "DC:
              57@ VALIDATED BY/REAS FOR HIGHER PRECEDENI@UE:
              96. AIRCRAFT IT         TN.ERARY:
                                      I
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