PATIENT FILE 29 OCT 90

File: 102896_aug96_decls1_0037.txt
Page: 0037
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@2                                                       PATIENT FILE                                                     10/27190
                                                                 PERSONAL DATA - PRIVACY ACT G,- 1974



                                                                                                                                        13. TIODE: A
            NAME:                                                   18. AUTHORITY #: fi3OlAOO3 2. SSAN:                                 3.  PRECEDENCE: R
        4@  97iqT: All                5. GRADE: E04                 6. AGE: 24Y              7. SEX: 14,           8. WT,.     140      9.  READY DATE; 300
        10. !so:                      11. POR:                               I       1                                                  12. SPEC CAT:
        '4, @REAS RES; DS             15. DATE LAST VISIT: 5 U.S.C. 552 (b)(6)                                                          16. CLASS: 3A
        17. ACCEPT PLI.YS:                                                                                                              19. APPT/SUPG DATE: Nio
        I                       @H                                                           21. CANC/l@IC-.                            22. VALID:                     @1LE    Y3
        @o. AFPROV AUT :
        23@ MTF NRIG: A5150           USA DISPENSARY DPAMRA\2                                                                           24, ICAG CRIC:        OEDR
        25. MTF DEST: F5070           USAFRriC i'41;-:GDADEN GE                                                                         26. ICAD DEST:        EDAF
        27. i'@E@. SPEC ': SOO        26. DiAir 1: 71601         OT -ER JOINT DERANGEMENT, NEC INVOLVING SHOULDER REGION'
        29. @1,ED SPEC 2@             'O. DIAG
        31. IIED SPEC 3:              30-. DIAG
        '2A. PROCEDUR'I
    1
        @5. 02/LP@@@: %'              @,6. SUCT:     N           37. NO TUBE: N'             36. RESP: N                          39. FOLEY:          N       40, STRYKER: N'
        41. li%ICUB2            N     42. iRP,'@T! N             43. !MED@ 1%,               44. @.A.ST/LGC: N                    45. TRACHT                  46@ @ON: N
        71@ PT BAG TYPE: ND                                      72. Pi BAG TAG                                                   73. PT BAG @-T:
        41, SUPP INT:O@ PT CAMPBELL KY                                                                                  28 CSP@


        40. MAX ENRTE 57,GPS: Y / 9                              49@ MAX # RONS. Y           / 9                                  50. ALT REST/MAX Hi: N 1
        53@ INPATIENT: Y              54. SPEC PROO:             VA DRUG        ALCOHOL        WT       NONE X                    55@ VA CODE:
        56. ADMIN/OVERSEAS:
        @s. VITAL SIG@NIS(TEMP/PULGE/RESP/BLOQD PRESS)- 099.6                         84 1     16 /     128 1      76
        59. HSti:                     60. HCT:                   61. AEG:                                          /DATE TAKEN:
                                      63. SI/VST;                64. MEDICATIONS: i4'iOTR!il 600        MS




        6@,@ HISTORY: FX MULTIPLE R SHOULDER D                   T61 RICATION. NOW FREQUENT. PT         UNABLE TO DO
        TOB @-AS SCHEDULED FOR SURGERY PRIOR TO DEPLOYMENT.








        66. ATT P@4YG: SCHMIDT                     67. PH#@ 000 0            0000                                  68. @4ARD#/PHIkt 000 / 000 000 0000
        69@ REPORTED BYt rtSGT        MARTI"                                                                       70. PH#: 000 0000
        74. ATTENDANT NAME                                                                                         75. STATUS:                             76.  GRADEG
           79. RELATIONSHIP TO PATIENT:
        60. BAG TYPE:                              81. BAG TAG                                                     82. BAG @'i:
        8 . ATTENin@Ai\'T       NIANE @2@                                                                          84. STATUS:                             85.  GRADE:
        86. ABE;                                   87. SEX.                      87A. VJT:                         BB. RELATIONSHIP TO PATIENT:
        09, BAG TYPE@                              90, BAG TAG                                                     91. BAG @4Ti
        92. TRANS ORIG PHONE                                     EXT:
        9--,. TRANS DEST PHONE                                   EXT:
        74@ ETA CRlr@ MTF(DATE/TlrE)i 000 1                                                                        95. ETA DEST @LITF(DATE/TI@lj: 000
        97. OTHER @@DMVENTS-.



        5'. MBN #: 0000/300                                                                                        52. RON LOC:
        57@ VALIDATED BY/REAS FOR HIGHER PRECEDENCE:
        96. AIRCRAFT ITIN'CRA@RY,                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