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File: 102896_aug96_decls1_0039.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
07:04:22 PAT-i-.-.NIT PT' **** 10/29/00
. . -,E
PERSONAL DATA - PRIVACY ACT OF 1974
l'o. KGDE: A
is. Arrplo
RITY 14: 0301AOO9 2. $SAN: 3. PRECEDENCE: R
4. STAT: Ali 5. GRADE: E07 AGC- 7L 7. SEX: il 8. WT! 185 9. READY DAT : 300
E
10. ISO: I'@ POR: 12. SPEC CAT:
14. @REAS REu@z DS 15. DATE LAST VISII: 5 U.S.C. 552 (b)(6) i6. CLASS; 3A
i7. AP,PEPI PHYS: 19. AD T/Sll G DATE: NO
@P@ @R
20. APPROV AUTH: 21. CANIC/I,%"U@ VALID: Y3
'7 TSPC
MTF DRIS: AS!50 USA D@ INSPRY DHAHRAN 24. ICAO ORIG: GED@
,5. MTF DEST: F5070 US,@FRM'u 'WIESBADEN BE 26. ICAD DEST, EDAF
28. DIAG 1: 7175 DERANGEMENT 0-- MENISCUS, NOT ELSEWHERE CLASSIFIED
29. NED SPEC 2: @'O. DIAG 2:
31, riED SPEC 3: @2. DIA'@
2A. OROCE@ iRE:
33@ SPEC DIET! N/ 34. !Vt 1
35. 02/LPt4: N 36. SUCT: N 7.7. far, TUBE: N 38@ RESP: N 39. FOLEY: N 40. STRYKER: N
41. TINP.UB: N 42. TRACI: N 43. IMED: N 44. CAST/LGC-. N 45. TRACH@ N 46. rON: N
7i. PT &AG TYPE. NB 72. PT BAB TAB 73. PT BAG k'T:
47. SLIPP INFO: IST BRIBADE, IST CAV, 3RD BAT T LION, 3RD ARMOR, F7 HOOD TX REPORTED BY:
SUB AREA JMRB
49. MAX ENRTE STOPS; Y / 9 49. MAX # RONS: Y 9 50. ALI REST/VAX HI: N
@3. !NPATIENTT Y 54. SPEC PR,3G-. VA DRUG ALCOHO@ 14T NONE X 55. VA CODET
56.A MIN/GV@@RSEA.S:
@8. VIIAL SIGN.S@TEM.P/@DULSE/RFoP/BLOOD PRESS): 098.2 60 24 / 130 / 88
59. Hu-B: 60. HOT: 61. ABG: I DATE TAKEN:
62. NBC: 63. SIIVSI: 64. MEDICATIO@NS! NONE
6@@. HISTORY: ACCUT--L R KNEE INJURY WI @4EMATHROSIS UNABLE TO WALK 'WIO PAIN, NEEDS
ARTH,OSCOPIC SCREENING.
66. ATT PVYS: FRASSICA 67. PH@: 000 000 0000 68. @IARD#./PHqi 000 OOCI 000 0000
1
69, REPORT D BYt HERRE@IANS 70@ PH#: 000 0000
.E
76. BRADE:
77. AGE: 78. SEX: 78A. kT-1 79. FZELATI OT%ISHT
.,P TO PATIENT:
SO. BAG ly@DE. 81. BAB TAB 82. BAG WT:
83. ATIENDANT NAME #2: 64. STATUS: 85. C@RADE:
86. ACE: 87. SEX; 87A. WT: BB. RELATIONSHIP TO PATIENT:
89. BAB TYPE: 90. BAG TAG 91. BAB WI:
92. TRANS CRIG PHONE c,XT;
93, TRANS DEST PHONE EXT:
94. ETA ORIG ViTF(DATE/TTIM-): Cioo 95, ETA DEST im@TF(DATE/TIM.E): 000
97. OTHER COJMF)ENIT
Is
5a. vignt #: 0000/300 52. RON' "OC:
57. VALIDATRD BY/REAS FOR HIGHER PRECEDENCE: 1
96. AIRCRAFT ITINERARY: 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