PATIENT FILE 29 OCT 90

File: 102896_aug96_decls1_0020.txt
Page: 0020
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@@@A-23                             PATENT FILE                                            10/29/90
                                                 PERSONAL DATA - PRIVACY AC] OF 1974



                                                                                                                     13. riOD': A
                                                         18. AUTPB
        NARE@                                                        RITY R: 0297AO20 2. S--'AN:                     3. PRECEDENCE: R
     4@ STA': All               5. BRA E: P04            6@ AGE@ 20Y            7@ SEX: M                  200       Y. READY DATEI 299
                           1            AD   -                                                     8, WT
     10. 190;                           POR:                     I                                                   12, SPEC 'uAT:
     14. F.EA.S            REG: DE '5. DATE 'LAST VISTTI 5 U.S.C. 552 (b)(6)                                         16. CLASS% 3A
     17. ACCEPT PHYS.      JMRO                                                                                      19, APPT/SURS DATE@ NO
     20. APPROV AUTH@                                                      21. u'ANC/Ii%'C:                          22. VALID:               'MK    Y7
     2 @i@,Tc OR           TG: A5@130 USA DISPENSARY DL4.A.@'RA%i                                                    24. ICAD ORIG@   GED@R
     25. @fTF              DEST; A3030 FRANKFURT ARMY RES 119D                                                       26. ICAO DEST:   EDAI
     27. i@'ZD             SPEC 1: SOD 20. DIAS 1: 7327 OSTEOCHONDRITIS DTSOC
     29. IED               SPEC 2: 30.  DTA
                                        i. C 2:
     7.1. riED             SPEC 32. DTAG 3:
     32A. PP.OCc@DURE@
     3,-,, SPEC DTP @      N/                                              34, !V:
                           @-T
   39@  R'CSP: N'                     39@ FOLEY:       N      40, STRYKER: N'
     41. l@%lu'UB @        iN   12. TRACT: N          4,-N. IMED:          44,  CAST /LOC: N                  4@.    iRA@@H.   i@     46. MON: N
     71. PT BAG TYPE: NB                              72. PT BAG TAG                                          73.    PT BAG ti!T:
     @7. SUPP INFO: ****DS*** HHI       1/7  @@AV 'r-T HOOD TX


     46. il.AX ENRTE STOPS: Y / 9                     49. MAX # RDi%@S: Y       9                             50.    ALT REST/riAX HT: N
     53. INPATIENT: Y           54. SPEC PROG:   VA      DRUG        ALCOHOL    WT     NONE X                 55.    VA CODET
     56. ADMIN/DVc@RSEAS;
     56. VIT I STONS(TEYiP/PULSE/Rc     P/BLOOD PRc@SS)- 099.0           62     20     110         78
                           .A,          Is.
     59. PSB:                   60. HCT;              61. ABG!                                     DATE TAKEN:
     62. NBC:                   63. SI/VSI:           64. MEDICATIONS: NONEE




     65. HISTORY: LONG H,10 KNEE PROBLEMS PAit@' IN LOOKING THREE ORTHOSCOP" SINIPE JAN 9
     0 FOR LOOSE 'BODY. CONTINUE LOCKING NEEDS        C A  P AOR
                                                      @VI.C @ 11








     6'0. ATT Ph'YS. M.AJ S,-,c,WARI         67. PH#: 000 000 0000                           66.   h'ADDP./PH#:      0  000 000 0000
     69. REPORTED BY; GUIDO A5150                                                            70.   PH#: 000 OLIOO
     74@@ AT EINDANT NAME 41@                                                                7i.   STATUST                         76, GRADE:
          ,T
     77. ICE-                                78. SEX.                78A. WT:                79.   RELATIONSHIP TO PA@IIEI\',T:
     80. BAG TYPE:                           61. DAG TAG                                     82.   BAG w'T:
ADE:
     86. AGE:                                67. SEX:                87A@ 1@IT:              8O..  RELATIONSHIP TO PATIENT:
     69. BAG lyPE:                           90. BAG TAG                                     91.   BAG WT-.
     92@ TRANS ,RIG PHONE                        EXT:
     93. TRANS DEST PHONE 4:                     EX?:
     94. ETA ORIG @iTF(DATE/TIriE): 000                                                      95.   cl,A DEST MTF(DATc@/TIME): 000
     91. OTHER COMMENTS:



     51@. MEN 4:                                                                             52. RON LOC:
     57= VALIDATED BY/REAS FOR HIGHER PRECEDENCE:                f
     96. AIRCRAFT ITINERARY;            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