PATIENT FILE 29 OCT 90

File: 102896_aug96_decls1_0036.txt
Page: 0036
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




           07:03@                                              DA-II@ T Fil                                          10"29/9Ci
                                                                    N@'@    @E
                                                     PERSONAL DATA - PRIVACY ACT OF 1974



                                                                                                                13.  MODE: A
      I. \?AM@L'                                         @,B. AUTHORITY #; 07.OIAOC)2 2. SSANI:                 3.   PRECEDENCE: R
      -1, STAT@ All             5. GRADE: E03            6@ AGE@ 20Y        7. SEX: @l        G. WT:     170    7.   READY DATE; 300
      io. iSO2                  @ll. POR:                                                                       12.  SPEP CAT@
      14, REAS REG: DS          15. DATE LAST VISIT: b U.S.C. 552 (b)(6)                                        16.  CLASS: 3A
      17. ACCEPT PHY6:                                                                                          19.  P.PPT/SURB DATE: NO
      20. P.@OPROV AUTH:                                                        NC/INC:                         22.  VALID:               rLE   Y@7
      2'@. r,.TF DRIS: A5150    USA DISPENSARY DHAHRAN                                                          24.  TCAD ORTI:   GEDR
      23. 14,'F DEST@ F5070     USAFRi',C WIESBADEN GE                                                          26.  ICAN@ DEST:  EDAF
      27. r,,ED SPEC l@ 6,30    28. DIAS li 71881    OTHER JOT NIT DERANGEri'---NT, NEC INVOLVING SHOULDER REGION
      29. NED SPEC 2:           30. DIAS 2:
      31,    SPEC 3:             DIpro 3:
      32A. PROCEDURE:
      33. S@LE'@ DIET, N/                                                34. IV:
      3-Q. Cl@/LPfl: N          36. SUCT.    N       37. NG TLIDE! N      38.  RESP: N                     39. FOLEYT          N  40, STRYKER: tl
       45. TRACH@          N  46. MON: N
      71. PT BAB TYPET NB                            7.@. Pi BAG TAG  4@;                                  7@'. PT BAB WT:
      47@ SUPP INFO. 17 CAMPBELL @Y                                                                28 CSH


      48. i@.Av ENRTE STOPS: Y / 9                   49. riAX # RONS@ Y  1 9                               50, ALT Rc,ST/riAX PT: N
      53. INPATIENT@ Y          54. SPEC PROS:       VA  DRUG    ALCOHOL       @'.4T NONE X                55. VA CODE:
      56@ ADVIN/OVERSEAS:
      ;B. VITAI SIBNS(iEimP/PULSc/RESP/B@IGOD PRESS): 098.2 1          84   /  16 /  130      85
      @9. @4BB:                 60. H'ul:            61. ABB:                  I              DATE TAKEN:
      b2@ WDP@@                 63.  SI/VSI!         64. M.EDICATIONS@ MDTRIN 600rS TYLENOL 3 325 MG




      65. LIISTORY: MULTIPLE PRIOR AINTERTOR R       SHOULDER DISLOCATION' WHICH HAVE BECOME MG
      @RE FREQUENT. PT NOW WITH EASILY SUBLUXABLF R SHOULDER WIASSN TATED PAIN.
      PRESENT SY,'IPC@wiS PBSRAVAT,CD BY RECENT FALL.







      66. ATT @DHYS: SCHMIDT                 67. PHt4.- 000 000 OOA@O                         66. WARD#/Pu#: 000 / 000 000 0000
      69. REPORTED BY: riSOT MARTIN                                                           70. P'H#- 000 OOCO
      74. AITENDA@NT NAME 4@l:                                                                75. STATUS@                      76. GRADE:
      77. AGE:                               78. SEX:             78A. WT:                    79. RELATIONSHIP TO PATIENT:
      80. BAB TYPE:                          81. BAG T 6                                      82. BAG i4T:
      83@ ATIEN'DAN, NAME #2:                                                                 84. STATUS-                      Si. GRADE:
      86. AGE:                               87. SEX:             87A. WT:                    68. RELATIONSHIP 10 PATIENT:
           91. DAC WT:
      92. TRANS O.RIG PHONE                          EXT.
      93. TRANS DEST PHONE                           EXT:
      94@ ETA DRIG MTF(DATE/TlMcl); 000                                                       95. ETA DEST MTF(DATE/TIME): O'VO
      97. OTHER Co@,'IrIP TO:
                      t'@ @ @



      54, M.SN #: OAIOO/300                                                                   52. RON LOC.
      57. VA;@IDA@tED BY/REAS FOR HIGHER PRECEDENCE:
      96. AIRCRAFT  T TT@ERARY:                      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