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File: 102896_aug96_decls1_0023.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-@@,5t2@- PATIENT FILE 10/29/90
PERSONAL DATA - PRIVACY AC-] OF 1974
13. MODE: A
l@ NAME: IB, AUTHORITY #: 0299AOB9 2. SSAN; PRECEDEN"@E: R
4. SAT@, Al' GRADEI E06 6. AGcl@. 32Y 7. ScX: @l 8. '4T: 2CF@ 9. READY DATEI 299
12. SPEC '@AT:
10. I ,ZG: II. POD 5 LJ.S.d. 552 (b)(6)
14. REAS REG: DS 15. DATE LAST VISit: 16. CLASS: 3A
17. PHYS@@ OMRO 19. ADPT/SURG DATE: NO
20. APPROV AUTH@ 2'. CA%ICIIN'U; L2. VALID: i iRL Y4
21@ rTF ORIG: A5150 USA DISPENSARY DHAHRAN 24. ICAD ORIG: OEDR
2'@. MTF DEST@ A5040 2i.\D GEi% HOSP LANIDSTUP.L 26. ICAU DESTI EDAP
27@ V@@ED SPEC 1: MMC 20. D-,AG l@ 4109 ACUTE MYOCARDIAL !NFARCTIOI%L OF UNSPECIFIED SITE
29. MED SPEC 2-@ ZO. DIAG 2@
31. V.,ED SPEC 3: @'2. DIAS 3z
32A. PROCEDURE:
SPEC DIET@ Y/@\10 SPECIAL DIET 34. IV:
1
35. 02/LPM: Ni1 6. SU'uT,, N 37. NG TUDE@. N. 38. REQP: N 37. FOLEY: N 40, STRYKER: N
41. '@N,CUB: N 41@. TRACT: N' 43. IMED: N 44. CAS-i/LGC@. iN 45. TRAP@Q@ -N 46. N
71. PT BAB TYPE- MD 72@ PT DAB TAG 73. PT BAG VIT.
47@ SU@'P iN'FO-. FT. SILL',;, OK REFORTED BY
44TP, MF:D BOD (5TH MASF,)
48. MAX ENRTE STOPS: Y / 9 49. MAX 0, RONS: Y 7 50. ALT REST/MAN HT; i%l
IN Tz V 54@ SPEC PROS: VA. DRUG ALCOHOL WT NONE X 55. VA COD':
13 1. PAT ICIN. a
@b. ADV@qN'/GVERSEAS:
58. VTT I SIGN-S@TEiIP/PULSE/Rt-SP/BLOOD PRESS); 097.0 i 64 i6 f 100 / 72
@,A- I
D, IAK
r.6 @ 60. HCT@ 6i. AB@ f DATE ' EN:
62, WBC@. 63. SIIVSI: 64@ MEDICATIONS: SYNEHROID, .25 MG PO IX DAILY; @,N'TTR
O-PASTE I 1erF@ EVERY 8 HRS.
65. FISFORT@ CHRONIC CPC,ST PAINS X 3 MONTHS. HAS LOS7 -_,o LBS LAST 2 MOS.D PATI
TIGUED MOST 'LT THE TIIME@ HISIORY REMARKABLE FOR R@RAVE'S DISEASE 7 YEAR
8 AGO. RECOMMENDED lo BE SENT OUT OF THE A,C@R.
66. ATT PFYS@ DR. ZURU@4S@KY 67. PH#; 000 000 0000 68. WARD#IPHO.@ 000 / 000 000 0000
69. REPORTED BY@ SGT @,ARCHANT 70. PH@: 000 0000
74. ATTENDANT NAME 41: 75. STATUS: 76@ GRADE:
77. AGE- 78. SEX,. 78A. @T: 79. RELATIONSHIP TO PATIENT@
80@ BAG tyPE: 81. BAD iAC 92@ BAB '@4T:
83@ ATTENDANT NAME 42: 84, STATUS: F@. GRADE:
86@ AGE. 87. 67tX: 87A. WT: 88. RELATIONSHIP TO PA@-IIEINT:
89@ BAG 7@YPE@@ 90. DAB TAG 91. DAG 'WT:
92. TRANS G@RIG PHONE EXT:
97@ TRANS DEBT PHONE @@XT:
94. A OR-'G imTF(DATE/TltT): 000 V@.@ ET DEST MTF(DATEITI@.E)i 000
A
97. OTHER COMhEiITS-.
51. yt'oN #@ 0000/299 52. RON LOC:
57. VALIDATED BY/RT:AS FOD HIGHER PR-'-CEDENI',E: 1
I I I
@F@
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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