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File: 102896_aug96_decls1_0034.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
07:02:39 **** PATTENri FILE **** 10/29/90
PERSn@iN-AL DATA - PRIVACY ACT OF 1974
1-1. @"ODE: A
18. AUI'HO 7..PRECEDENCE: R
l@ @NAMEI RITY #: 0299ACFj2 2. SSAN:
4. STAT- All 5. GRADE: 'ZO5 6. AOEI 29Y 7. SEX: M 8. 14T: 165 9. READY DATE! 299
IC. 160: 11. POR: 1 12. SPEC CAT:
14. @O@CAS @R@o: DS l@@. DATE LAST VISIT: 5 U.S.C. 552 (b)(6) 16, CLASS: 3A
17. ACCEPT PHYS: JriRO 19. APPT/SURB DATE: NO
@o. APPROV AU@SH: 21. CANIC/iNC: 22. VALID@ I LmK Y7
@3. riTF O@1'6: A5,5t) USA DISPENSARY D@'AuRAil 24. ICAO DRIG: DEDR
25. MTF DEST; F5070 WIESBADEN GE 26. ICAD DEST: EDAF
27. ilED SPEC l@ 600 28. DIAS 1: 83100 CLOSED DISLOCATION OF S,'@OULDED, UNSPECIFIED SITE
29. rED SPEC 2: 30. DIAS 2i
31@ MED SPEC -,,2 32@ D'@A'G 3-1
32A. PROCEDURET
3-11. SPEC DI- :NI 34. IV:
@CT
7. NS TUBE: N 39. REc@p: N 39. FOLEY: N 40. STRYKER. N
41. INCU@ N42. TRACT: N 43. TVIED: 1\1 44. CAS'E/LGC@ N 45. TRACH: N 46. 0,0,\]: M
71. PT BAD TYPE@ ND 72. PT BAB TAG 73. PT BAG k4T:
47. SliPP INFO: D CO AMC 82D ABN FORT BRAGB, NC REPORTED BY
28 @ISH@ ****DS***
46. MAX ENRTE STOPS: Y / 9 49, MAX # RONS: Y 1 9 @@0. A',T REST/@IAX HT:
,3. IiNPATIEN'.-I: N 54. SPEC PROG: VA DRUG ALCOHO' WT NONE X 55. VA CODE;
56. ADimIiN/DVERSEAS:
q AL glroNS(iEMP/PULSE/RESP/BLOOT,' PRESS):
@8. VITA
59. HOD: 60. HC-1; 61. AEG: DATE TAKEN:
62. NBC: 63. SIIVSI: 64. MEDICATIONS: NONE
65@ @,'l-S7sGRY@ DISLOCATION TO R'GAL SHOULDER X2 IN JL'M,@IN'u ACCIDENT APX 8 MONTHS A
'@T. CHRONIC INSTABILITY.
66. AiT PHYS: @qAJ AI,r'LRICC 67. PH-ii: 000 ODA 0000 68. @IARD#/PH#: 000 I 000 000 0000
69. REP[IRTED BY@ GIJT DO 70. P@4'#t 000 0000
74. ATTE!NDAI\'T NAME 41: 75. STATUS. 76. GRADE:
77. AGE: 79. SEX: 76A. @IT: 79. RELATIONSHIP TO PATIENT:
60. BAG lyPE: 81. BAD TAG #t 82. BAG WT:
S: 85. ODADET
B6. AGE2 87. SEX: 87A. WT! BS. RELATIONSHIP TO DATIENTI
89. BAG TYFT: 90. BAG TAB 91. BAG V,T:
92. TRANS GRIG PHONE *t EXT:
93. TRANS DEST PHONE §-. EXT:
?4. ETA ORIS jITF(,nATE/TIME)@ 000 95. ETA DESI MTF(DATE/TIME)i 000
97@ ONER Plor@ViENTS:
51. V.Si\l #: 4123/299 52. RON LOC:
57@ VALIDATED BY/REAS FOR H16HER PRECEDENCE:
?6. AIRCRAFT ITINERARY: I i
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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