PATIENT FILE 29 OCT 90

File: 102896_aug96_decls1_0027.txt
Page: 0027
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




              07: 00; 'z6                                                 PAILE@IT Fl@'F                                                  IC,/29/90
                                                          PERSONAL n TA - PRIVA,- ACT OF 974
                                                                      @A                  @y



                                                                                                                                   13. MODE: A
                                                                   18. AUTHORITY                      2. SSAN                      3.  c-R-@CEDE,@CE: R
       4.  STAT;    All             5. GRADE: '=04                 6@ AGE@ 'L2Y           7@ SEX: ti          8. 'AT.     180      9.  READY DATE: 301
       10. !So:                     11, POR:                                                                                       12. SPEC P@AT@
       14. REAS REG; DS             '5. DATE LAST VISIT:           5 U.S.C. 552 (b)(6)                                             16. CLASS: IC
       17@ ACCEPT PFYS-                                                                                                            19, APPT/SURG DATET NO
       20, APPROV AUT.H:                                                                  21. CANC/ICC:                            22. VALID:                 I
       2-@. MTP BRIG: A5150         USA DISPENSARY DP.AFRAN                                                                        24. ICAD CRIS:        OEDR
       25. VTF BEST-. A5030         FRANKFI 1.@T          -CG M'CD
                                              I ARMY R,                                                                            26. ICAU DEST:        EDAF
       27. Yi'ari SPEC 1: MPPS      @. DIAG 1: 3019          UNSPECIFIED PERSONAL         TTY DISORDER
       29. r,,ED SPEC 2:            30. DIAG 2:
       31, tti;7D SPEC 3:           32. DIAG 3:
       32A. PROCEDUREI
                                      34. 'V; @l/
       35. 02/LPr,: N               '@6. SUCT:     N         37. NG T BE: N               39. RESPT N                         39. FOLEY:             N   40. STRYKER: N,
       41. l@,%"UUB:      N         42. TRACT: N             43, l@1,ED: N                44. CAST/LOCg N                     4-0. TRACH.:           N   46. tMn.,N: N
       71. PT BAG TYPE. NB                                   7?. ri BAG TAB       l@                                          77@ PT BAG W':
       47. SLI@OP INFDT F'l CAMPBELL                                                                                5 riASH


       48. MAX @,N@R-iF STOPS: Y / 9                         49. MAX t RONS: Y            / 9                                 50@ ALT REST/ViAX HT: N
       5-,O. INPATIENT: Y           54. SPEC ?ROB:        VA       DRUG       ALCOHOL       WT      )NONE X                   55, VA CODE:
       56. ADMIN/OVERSEAS:
       16. VITAL SIGNS(TEMP/PULSE/RESP/BLOOD PRESS)T 098.6                        063 /     16 /    120       060
       59. H.S@                     6t). HOT:                61. ABS:                                         DATE, TAKEN:      301
       62. WB'@:                    63. SIIVSI:              64. VIEDICATIONS@ I\'ORFLEXIN 400 MG POSID




       6@'. HISTORY: PERSONALITY DISORDER EVALUATED BY PSYCHIATRIS-I. RECOMMEND PT BE
         .NT
       SE I OUI OF THE ACR@








       66. ATT PHYSI NONE                          67. PH#-. 000 000 0000                                     68. WARD#/PP,#@ 000 / 000 000 0000
       69. REPORTED BYz ViS'uT MARTIN                                                                         70. PP,#: 000 0000
       74. ATTENDANT NAM.C@ #i:                                                                               75. STATUS:                            76. GRADE:
       77, ASE:                                    76. SEX:                    78A@ 6'Tt                      79, RELATIO@NSPJP TO PATIENT:
YPE:                               81, BAG TAG                                                92. BAG 'w'T:
       83@ ATTENDANT      NAME 42t                                                                            64. STATUS:                            85@ GRADE:
       86. AGE:                                    87@ SEX;                    67A. 1,4T:                     88. RELATIONSHIP TO PATIENT:
       69. BAS TYPET                               90. BAG TAG 4:                                             91. BAG @IT-
       92@ TRANS BRIG PHONE                               EXI:
       93. TRANS DEST P@LL@NE                             EXT:
       94. ETA BRIG @MTF(DATE/TlrE)i                                                                          95. ETA DEST MjF(DATE/TIME)i
           OTHER COMMENTS:



       51. @SIN #: 0000/301                                                                                   52. RON LUC:
       51. VALIDATED BY/REAS FOR HIGHER PRECEDENCE'
       96. AIRCRAFT       TTINERARY:           f                   I
                          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