PATIENT FILE 29 OCT 90

File: 102896_aug96_decls1_0028.txt
Page: 0028
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;52                                              **** PAT',ENT PILP ***?-                                                 10/29/90
                                                           PERSONAL DATA - PRIVACY ACT OF i974



                                                                                                                                      13.   IMODE: A
           NA@,F-:                                                 16. AU' ORTTY #; 030OA021 2. SSAN:                                 3.    PRECEDENCE: R
     4.    STA  : All                5. GRADE; P-04                6. AGE: 25Y           7. SEX; ri              S. WT:       161     9.    READY DATE: 300
            AT
     io.   ISO:                      11. POR.                                                                                         2.    SPEC CAT:
     14,   REAS  RL'G: DS            15. DATE LAST VISII:              5 U.S.C. 552 (b)(6)                                            6.    CLASS: 2B
     17.   ACCEPT PWTS;              J@'JRO                                                                                           19.   APPT/SURS DATE: NO
     20@   APPROV AUT :                                                                21. CA@l@I/IN@                                 22.   VALID:                   ViL@c   Y,-N
     23,   MTF GRIG: A.5150          USA DISPENSARY DHAHRAN'                                                                          24@   TCAN ORIG:      GEDO
     25.   MTF DEST: A5030           FRAN.,'PURT ARMY Rcu     TIED                                                                    26.   TCAO DEST:      cjAF
     '47@  FIND SPEC 1: 900          28.  DT AS l@      71916 H'amARTHROSIS INVOLVING OTHER SPEPIF               TED 91' S
                                          I                                    I                                       iE
     20@   DIED SPEC 2:              30. DIAS 2:
     31.   r!ED SPEC 3:              32. DIAS 3:
     @,2A. PROCED RE:
    ,,3,  SPEC 'UIETG               i\!/                                              34. IV:
     35.   02/LPm,. hl,,             36@ SL"I:          N'    7,7. NG TUBE: N          32. RESP; N                              39. FOLEY:            N     40. STRYKER@ N
     41.   T@NCUB.       l@,         42. TRACT-,        iN    43@ lilED: N             44. 'uAST/LOC: N f                       45. TRAC@Q:           @l    46. riON: N
           PT BAG TYPE:                                       72. PT BAG TAG                                                    771. PT BAG      1,4T:
     47.   SE@PP INFO: F CO          24 AIJKT DN O@4    !NF DIV FT STEWART, CA                                        REPORTED BY
     2
     46.   MAX ENRTE STOPS:                                   49. MAX # RONS@                                                   50. ALT REST/riAX HT:
     I     T
           INPAil@!T:                54@ SPEC PROS:        VA      DRUG        ALCOHOL       @'T       NONE                     55. VA CODE:
     56.   ADMIN/CVERSEA@
     59.   VITAL SiGNS(TEMP/PULSE/RESP/BLOOD PRESS):
     59.   F@GB:                     60. FCT:                 61. ABO:                       I         I         / DATE TAKEN2
     6'L.  WBC@@                     63. SI/VSI!              64. YI.ED L'ATIOINS:




     65.   HISTORY@










     66@   ATT P,@YS:                                   67. PF,'@:                                               68. WARD /PH#:
     69@   REPORTED BY:                                                                                          70. PH#:
     74@   ATTENDANT NAME #1@                                                                                    75, STATUS:                             76. GRADE@
     77.   AGc@,,                                       76. SEX:               72A. 14':                         79, RELA[IONISHIP TO       PATIENT;
     80@   'DAG TYPE:                                   81. BAG TAG                                              92. BAG WT:
,-ITcl%!DAiJT NINE #2t                                                                               84. STATUS:                             85, GRA.DET
     06.   AGE:                                         07, SEX@               87A. WT:                          88. RELATIONSHIP TO        PATIENT:
     89.   BAG TYPE:                                    go. I G T 6                                              91. BAG k'T.
                                                        DA    @A
     92.   TRANS CRIG PHONE                                EXT:
     93.   TPP.Nlc. DESI PHONE                             EXT:
     94.   ET n 16 MTF(DATE/TLME)-                                                                               95. ETA DEST rTF(DATcjTlMc@,)g
            @A D
     97@   OTHER COMrjFN@'Tg:



     51.   MN t@:                                                                                                52. RON LO'@:
     57.   VALIDATED BYIREAS FOR HIGHER PRECEDENCE:
     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