PATIENT FILE 29 OCT 90

File: 102896_aug96_decls1_0024.txt
Page: 0024
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




              I                                                      T i@,,T
              ,16:59:32                                          PATIE I FILE                                              iO/29190
                                                    PERSONAL DATA - PRIVACY ACT O@ 1974



                                                                                                                       13. iyio@u C: A
              1. i'@Ari                                    18. AUTHORITY #: 030OA000@ 2. SSAN:                         3.  PRECEDENCE: R
              4. STAT@ Ali      5. CRAD'-MI E05            6. AGE: 22Y        7. SEX; @@m          8. Wi@    195       9.  READY DATE: 299
              10. 180:          il@ PORI                                                                               12. OPEC P@ATT
              14. PEAS REC@ DS  15@ DATE 'LAST VISIT;                                                                  16, CLASS: 2B
              17. ACCEPT P@@'YS;                            5 U.S.C.       552 (b)(6)                                  19. APPT/SURG DATE:    NO
              20.AP OV AUT,4@                                                21. CANC/INC:                             22. VALID:               ML@c    Y6
              ,P@ R
              23, @'@TF GRIG: Rjl5O USA DISPENSARY DHAHRAN                                                             24. I@@AO ORIGI    OEDR
              25. @YITF DEST@ F5070 USA.FRMC t4Ic@SEADEN GE                                                            26. IP@AD DES-]:   EDAF
              27, ?@ED SPEC 1: 600 28. DIAS 1: 895@@  TRALI,@LATIC AMPUTATION OF IOE(S) @COMPLETE)       (PARTIAL)
              29. 4ED SPEC 2.   30. DIAG 2.
              31@ @M'CD SPEC 7@: -',2. DIAG 3;
              2A. PROCEDURE:
              33. SPEC DIET: I%'/                                            34, IV:
 STRYKER: N'
              41. I@N@'UB:N     41@. TRACI:   N       47@, ITMED: k'         44.  CAST/LOC: @N                   45. TRAC'r":      n'     46@ MON: N
              71. PT BAG TYPE: NB                     72. PT BAD TAG                                             73, PT BAG WT:
              47. SUPP INFO: HWB 13 ACR, FT Bi ISS TX                                                    REPORTED BY:
              SUP AREA. J@NRO
              48. MAX EINRTE STOPSI Y / 9             49. MAX # RONS: Y         9                                50. ALT REST/MAX qT: N
              53. INPATIENT- Y  54. SPEC PROG:      VA     DRUG      ALCOHOL      WT     NONE X                  55, VA CODE:
              56AMTiN/OVERSEAS:
              AD I
              58, VITAL SIGNS(TFMP/Pl,LSE/Rc,SP/BLODD PRESS); 097.6 /       80    20 f    106      58
              59. HGBT          60. HOT:              61. ADS:          I                          DATE TAKEN:
              62. WB'6:         63. SIIVSI:           64. tIEDICATIM,@IS: ?@OTRIN 600    MC L'8 HRS PRt\l




              .6@. HTSTO@RYT I HA.' UX PARTIAL TRAUMATIC P.MPUTA7i!ON / TRUCK RAMP DROPPED ON LEFT
              GREAT TOE X 10 DAYS AGO.








              66. ATI PHYS: TUTT R            67. P #@ 000 000 0000                             68.      WARD#/PH#:    0   000 000 0000
                                .E
              69@ REPORTED BY: HERREwP.,\'S                                                     70.      PR#: 000 0000
              i4. ATTENDANT NAME '@l;                                                           75.      STATUS:                      76. P@RADE:
              77. AGE:                        78. SEX@                76A. W':                  79.      RELATIONSHIP TO PA:,IENI:
              60. BAG TYPE.,                  81. BAG 'AG                                       82.      BAG @iT;
              8-5. ATTENDANT NAME 4@2:                                                          84@      STATUS@                      85. GRADC@:
             96. AGE.                        87. SEX@                87A. WT@                  88.      R@CLATTONSPjp T PATIENT:
                                                                                                                       .0
              89. BAG iyPE:                   90. BAS TAG                                       91.      BAG WT:
              92. IRAI'IS ORIS PHONE #i             EXT:
              9@ TRANS DEST PHONE #-.               EXT:
              94, ETA GRIC MTF(DAT@--/T',@IE); 000                                              95.      CT DEST NTF(N Tc/TI@X-E)t 000
                                                                                                         .A            A
              97. OTHER COMMENTS:



              m N #:      49
              is          0000/' 7                                                              52. RON LOC;
              57. VALIDATED BY/REAS FOR HIGHER PRECEDENCE:         I
              96@ AIRCRAFT ITINERARY:

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