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File: 102896_aug96_decls1_0017.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@51:44 **** PAIIENT FILE **** '0129/90
PERSONAL DATA - PRIVACY ACT OF 1974
I'@ 14.ODE: A
18. AUT,4'DRi
'TY #@ 0299AOOI 2. SSAN: 3. PRECEDENCE: R
4. STAT@ All 5. GRADE: E03 6. A'oEi 19Y 7. SEX: 8@ WT, 123 9@ READY DATE: 298
10. 190: 11. POR: 12@ SPEC CAT:
14, REAS REC: DS 15@ DATE 'LAST VISIT: 16. CLASS: 3A
@7. ACCEPT PHYS: 5 U.S.C. 552 (b)(6) i9. APPT/SURS DATE: NO
20. APPROV Alilp,: 21. 'uAN@'/INC: 22. VALID: P@EA Y4
23. MTF ORIG: A5150 USA DISPENSARY DHAHRAN '@4. ICAG DRIG: DEDR
25. @'iTF DEST@ F5070 USAFRVC WIESBADEN r 26. ICAD DEST: EDAF
27, t,!ED SPEC 1: SOP 28. DIAG 1: 7271 BUNION
29. NED SPEC 2: 7
10. DIAS 2:
31. ivED SPEC 3: 32@ DIAS 3:
32A. PROCEDURE:
34. IV@
3@@. 02/LPM: KI 36. SUP@T: @q @-7. NG TUBE: N 38. RESP. N' 39. FOLEY: N' 40. STRYKERT N
41. IN'-US, N 42. TRACT-. N 43.IFRED: N 44. CAST/LOC: N 45. TRACH: N 46. riON@ N
71= PT BAS TYPE: NB 72. PT BAG TAB 7@'. PT BAG WTi
DTSCDIM
47c SUPP INFO: HHC 82"D AIRBORNE FT BRAGG NC REPORTED BY:
C,'-4.AV,PIC@4 MAIN
48. @1,AX ENRTE STOPS: Y 1 9 49. M.AX @ RONS: Y 9 50. ALT REST/r@AK HT: N 11
53, 1?4PATIENIT@ N 54. SPEC PROB: VA DRUG ALCOHOL 141 NIONE X 55, VA CODE:
56. ADNIN/DVERSEAS:
@8. VITAL SIGNS(TEMP/PULSE/REEP/BLOOD PRESS)@ 097.2 83 16 109 69
59. HSB: 60. HCT: 61. ABB: DAIE TAkt-:N'-.
62. NBC: 63, SI/VST; 64. MEDICATIONS- NONE
6--l. HISTORY: EL-LPT @'ALLUX VALGIJS DEFORMITY, 16 MONTHS SYSTEMATIC. CDR DETERMIJN
ED UNFIT FOR DUTY.
66. ATT PHYS: COMPTON 67. PFrif: 000 000 0000 63. WAIZD#/PHil.: 000 I 000 000 (@1000
69. REPORTED BY: HERFrcrANS 70. PH*: 000 0000
74@ ATTENDANT NAME #I: 75. STATUS: 76. GRADE:
NSHIP TO PATIENT;
80. BAG TYPE: 81. BAG TAB 82. BAG WT:
83. ATTENDANT NAME 4-2@ 94. STATUS: 85. 6,RADE;
96. ABEI 87. SEX: 87A. WT. 88. RELATIONSHIP TO PATIENT:
99. BAG TYPE': 90. BAG TAB 91. BAG WT:
9@@ TRANS ORIG PHONE EXT:
1
93@ TRANS DEST PHONE EXT:
94, ETA OR@LG iMTF(DATE/TItIE): 000 95@ ETA D@cst MTF(DATE/TLME)i 000 1
97. OTHER COMMENTS:
5i. nN '@: 0000/296 52. RON LOC@
57@ VALIDATED DY/REAS FOR HIGHER PRECEDt-N@4Et
96. AIRCRAFT ITTNIPRARY@
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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