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File: 102896_aug96_decls1_0016.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
06:51 PPTTENT FILE 10,129/9(j
PERSONAL DATA - PRIVACY ACT OF 19i4
V@n@D--@z A
NAME: 16. A.IJTF@OR TTY #i 00 SA@46 2, SSAN: PRECEDENCE: R
@9 1
4, '--TAT@ All 5. GRADE; E05 6@ AGE: 30Y 7. SEX: F S. 'k4T-@ 149 9. READY DATE: 298
10. lo@e: II. P@'P,. 12. SPEC @,At-
10 16. CLASST 3A
14, REAS R@ : DS 15. DATE LAST V751T@ 5 U.S.C. 552 (b)(6)
17@ ACCEPT PHYS; JVPC 19. APFT/SURS DATE: NO
2v@,AOPRR@'V Al." 21. CANC/INC; 22. VALIDT I Li@'K Y4
!H
23. rTF GRICT A5150 USA DISF'TNSARY D@'APR.A\l 24. ICAO GRIG: GEDR
25. MTF DEST@ F5070, USAFRIIC WIESBADEN GE 26. ICAD DEST: @DAF
27. VIED SPEC 1: SSE 28. DIAG 1: 57420 'UPLCUI@US OF CALIJLADDEP,
70. DIAG 2: 57420 CALCULUS OF GALLBLADDER
31. INEnd SPEC @ 32. D'AG
-@A. PROCEDURE:
@3. SPEC DIET@ NI/ 34@ IV:
35. 02/LPVi: %@ 1 36. SU'@T: ',K7. @,16 TUBE: N 38. RCSP: N 39. FOLEY: N 40. STRY R: N
41@ l@4CUB@ N 42. TRACI; il 43, IIIED. N 44. CAST/LCC-@ N' 45. TRACH: X 46. MON:
71@ PT BAB TYPE@ NB 72@ PT BAD TAG 73. PT BAB 'AT:
47. SUPP TNFG: A 724TH SUPPLY; FT, STEWART, GA REPORTED BY
28 @LSF@
48. MAX ENRTE STOPS: Y 1 9 49. X # RO@NS: y 9 50. ALT RESI/MAX HT: N
53. INPATIENT: Y 54. SPEC PROG@ VA DRUG ALCOHOL @ll NONE X 55@ VA CODE:
56. ADNIN/DVERSEAS4
56, VITAL SIBNS(TEMP/PULSE/REISP/BLOOD PRESS)I 097.6 1 80 16 1 120 74
@9. p@GE: 60. PCT: 61. AEG: I DATE TAKEN:
62, WBC: 63. SI/VSI: 64. 4---DICATIONS@ NION@@
6@'. HISTORY: PT ATTACHED TO FROi\li-LIN-L 97CIPPLY UNIT; UNDERWENT BILIARY CULIP., U/S
P@n@N!cTRN@iED MULTIPLE SMALL STONES. PT TS NOW ASYMPTOJNATIC; REQUIRES SURGERY AND
8 WEEKS CON! LV WITH IT raHT UDTY, RECOMMEND PT PAVE SURGERY AND CON LV OUT OF I
HE ACR
66@ ATT PPYS: YO'4'LER 67. FF.#; 000 000 0000 66. 0,ARD#/PP@#@ 000 000 000 0000
BY: DENITON' 70. PF@t-, 000 0000
74@ ATTENDANT NAME #I: 75. STATUS: 76. 6RADEz
77. AGE; 76@ SEX: 78A. WT@ 79. RELATIONSHIP TO PATIENTQ
81. BAG TAG I
80, BAB TYPE: 82, BAG 4T-
83. AiTENDANT NAME #2: 64. STATUS: 85. GRADE:
86, AGE2 87. SEX@ 87A. 1,4T@@ 88. RELATIONSHIP TO PATIENT-.
89. BAB TYPE: 90. BAG TAG 91. BAG @IT:
92. TRANS CRIG PHONE EXT:
9'3. TRANS DEST PHONE EXTI
94, ETA ORIS 0,TF(DATE/TlMr),. 000 95. ETA DEST tMTF(DATE/TlrjE); 000
97. OTHER COMMENTS:
@@l@ MGN #,, 0000/298 52. RON LD'U:
VALIDATED BY/REAS FOR HIGHER PRECEDENCE:
96. AIRCRAFT 'I T@ERARY: 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