Document Page: First | Prev | Next | All | Image | This Release | Search
File: 102896_aug96_decls1_0031.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
0,7:(Ilt39 PATIENT FILE 10/29/90
PERSONAL DATA - P.RTVAP@Y ACT OF '974
13. @",,DDE: A
I Namc. TTY @: 030OA020 2. SSAN: 3. PRECc@DENICEi R
'B. AUTHOR.
4: STA,@T@ P.11 5@ BRA E.@- 6 6. AGE: 30Y 7, SEX; M S. @IT: 165 9. READY DATE: 300
l(l. ISO: il@ FOR@ 12. SPEC CAT;
14, @RP-AS REG., DS 15. DATE LAST VISIT: 16. CLASS: 3A
'7. ACCEPT PDYS. 3@MRO 5 U.S.C. 552 (b)(6) 19. APPi/O@URB DATE: NO
20@ AOPROV AIJTH@. 21. CAi\-C/I@l,"@: 22. VALID: MLE, Y3
2@-, @MiF ORIG: Ai'L50 USA DISPENSARY DHAHRAN 24. ICAG ORIS: OEDR
z5. e@TF DEST, F@@IV70 USAFRN 'AIESBADD4' S@, 26, !CAG DEST: EDAF
27. @P-D SPEC I- Sgd 29.DTAG l@ 5929 URINARY CALCULUS, UNSPECIFIED
. DIA.@ 2;
711. t,@i'CD SPEC : -,,2@ DIAS 3:
32A. PROCEDURE:
33@ SPEC D-iE[: N/ '4. IV: i
7 0 @EY N' 40. STRYKER: N
.5@ 02/LPiM: N 36. SUC': Ni 37. NG TUD'LT N RESP: N 39@ FOI :
41. TN'@LIB- N 4'z. TRACT:N 43. IMED: N 44, CASTILO@@: N 45. TRALH: N 46. MGNT N
71. -7, BAB TYPE@, ND 72@ PT BAB TAG 73@ PT BAG WT:
47@ SUPP INFO: 1/17 CAV 82 ABN DIV FT BRAGG, NC REPORTED Y
28
49@ TAX @LNRTE @-TOPS, Y / 9 49. TAX # RONS: Y / 9 50. ALT RESi/@IAX HT: N
53. INPATIENT: Y 54. SPEC PROra! VA DRUG ALCOHOL '4T NONE X @-5. VA CODE:
,6. ADM!t@'/OV@.RScAS:
58@ VIIA'@ SIG@,'S(-IEMPIPULGE/R@@SP/DL@UOD PRESS): 098.5 70 1 18 120 76
59. @4BB: 60. HCT: 61. ADG: I DATE TAKEN:
611. NBC: 63. SIIVSII 64. MEDICATIONS: NONE
65. HISTORYT PEOC'LUR'EINT CYSTI,\'P- URGI-ITHIASIS
HAS PASSED SEVERAL ST NES
.0
I
66. AT) PHYS: MAJ FOX 67. rJH4: 000 000 0000 68. 1.4ARD4/DF,#: AVO 000 000 0000
69. REPORTED BY: UDTDO 70. pH#: 000 0000
74. ATTENDANT NAME #I: 75@ STATUS: 76. GRADE:
77, AScl: 76. SEX: 78A. WT-. 79. RELATIONSHIP TO DATIENTi
80. BAB TYPE@ 81. BAB TAG 82. DAG WTi
63. q-.ITENDAi@T NAME #2-. 814. STAIUS. 85, GRADE:
66, AGE: 87. SEX: 87A. WT: 88. RELATIONSHIP TO PATIE,%'Tt
87. BAG TYPE-, 90. DAo TAG 91. BAB @IT:
92. TRANS ORIG PHONE EXT:
9-7. TRP,,N'S DP-ST PHONE EXT:
94. EiA ORIou ?jiF@DATE/TIME): 000 95. ETA DEST -MTF(DATE/TT,'IE): 000
?7. OTHER COMMENTS;
51. YiS@k, 00001300 52. RON LOP@:
@7@ VALIDATED BY/REAS FOR HIS,@'c.R PRECEDENCE:
96, A47RCRAFI TTTINERAD
Ily
Document Page: First | Prev | Next | All | Image | This Release | Search
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