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File: 102896_aug96_decls1_0035.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
0,7:02;5f.,. PATIENT F?L@ 10/29/90
. i @
PERSONAL DATA - PRIVACY ACT OF 1974
13@ @',,DDE: A
',N 18. AUTHORITY #: 0299AO48 2. SSAN 3. PRECEDEK'-uE@ R
AME.
ST 11 All
4@ @Al t. ERADE@ E03 6. AGE; 23Y 7. SEX: M l,4T: 190 9. READY DATE: 299
10. ISO; 11. po@@: 12. SPEC CAT-.
14. REAS RES: DS '5. DATE 'LAST VISIT: 5 U.S.C. 552 (b)(6) 16. CLASS: 3A
AP EPT PPYS: jrid 19. APPTIO RC DATE: NO
@c @ @10 U
20, APPROV AUTH@ 22. VALID: f LMK Y7
21-. i@TF DRIG: A5!50 USA DISPENSARY IL,,'PHRAkl 24. ICAO ORIG: 0-@DR
25. riTF DESTI A5030 FRA
,AN FURT ARMY REG MED 26. IP,AO DEST: EDAF
A,
.7. VIED SPEC 1: MMI 28. DIAO 1: 78650 LINISPEP@TFIED CHEST 0 TN
29. '@A.ED SPEC 2: 30. DIAC 4':
32@ DIA6 'o;
32A. PROCEDURE;
33. SPEC DIET- NI 34. IV:
35@ 02/LPtl: %' 36. SUCT: N 7@7. NG TUBE: N 36@ RESP: % 39. FOLEY: N 40. STRYKER: N'
41. TNl@@UB: N42. TRACT: N 43. I@IED2 N 44. CAST/LOP.: N 45. TRACH: @N' 46. R@ONI: i@
71. PT BAB TYPE: NB 72. PT BAB TAG 73. PT BAB WT:
47. BURP INFO; 59TH CHEMICAL CO FT DRUi4, NY REPORTED BY
28 CSH ***DS****
48. MAX @CNRTE STOPS: Y / 9 49, MAX # RONS: Y / 9 50. ALT REST/MAX HT: N
53 . TNPATIC T4 N 54. SPEC PROB: VA DRUG ALCOHOL WT NONE X 55. VA CODE:
,6. ADMI.@IIOVERSEP.S2
38. VITA' SIONS(TEik'iP/PULSE/RESP/BLriOD PRESS); 110 60
1 @
59@ @SE: 60. quit-. 61. ABG- I DATE TAKEN:
62. 'ABC@ 63. SI/VSI: 64. III.EDTCAT70NS: NAPROCYN @90 VS BID
6@@. HISTORY: FIVE YEAR HISTORY OF RECURRENT LEFT SIDF CP@c@57, PAIIN,
PAI@ APPROXITNENTLY ONE WEEK AGO, RECnli4iim.Ei%ID TREATMENT BUT OF AOR.
66. Ail 'PYS: MAJ YOST 67, PH@: 000 OCIO 0000 68. Ik@ARD#/PP.#: 000 / 000 000 000
69, REPORTED BY-. SUIDO 70. PH#: 000 0000
74. ATTENDANT NAME #I: 75. STATUS2 76. GRADE:
RELATIONSHIP la PATIENT:
90. BAD TYPE@ 91, BAG TAG 82. BAG WT:
83. ATTENDANT NAVE #2: 64. STATUS: 85. GRADE@
66. AGE: 87. SEX: 67A. WT: 88, RELATIONSHIP TO PATIENI:
89@ BAB TYPE: 90. BAD TAG 91. BAB WTi
92. TRANS DRIG PHONE EXT:
93, TRANS DEST PHONE EXT;
94, E-iA OPIS @'@'iTF(DATE/TIrE): 000 1 95. ETA DEST MTF(DATE/TIME): 000
97, OTHER COMMENTS:
51@ rign 4: 4123/299 52. RON LO@@:
57@ VALIDATED BY/R@LAS FOR HIGHER PRECEDENCE:
96. 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