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File: 102896_aug96_decls1_0040.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
07iO4t45 PATIENT FILE 10/29190
PERSONAL DATA - PRIVACY ACT OF '974
13. @IDDE: A
1 3. PRECEDENICE@ R
NAME G. AUTHORITY #, 03OIA008 2. SSAN: m
4. STAT 6. AGE: 45Y 7. SEX: i4 B. WT: 190 9. READY DATE@ 7100
10. ISO: 11. POR: i SPEC CAT:
,4. REAS Rc : DS '5, DATE LAST VISIT 16. CLASS: 3A
17. ACCEPT PHYS: 5 U.S.C. 552 (b)(6) 19. APPI/SURG DATE: NO
20. APPIOV AUTQ: 21. CAN@IIINIC: 22. VALID: M.Li: I Y@o
23@ MTT' DRIE@ A5150 USA, DISPENSARY DHAHRAN 24@ ICAD ORIS: CEDR
-6 @uAU DFST@ EDAI-
L5. i@iTF T,EST- F5070 LISAr'F,',MC WIESDADEN B c ') @ T'
27. VIED SPEC it SOO 28. DIAG it OZ60 T AR OF MEDITIL CARTILAGE OR @MENI'SCUS OF KK.FE, CURRENT
.E
29. McD SPEC 2: 30. DIAS 2:
31. ?iED SPEC 3: 32. DIAS 3:
'2A. PRO@ DU'
E @F
33@ @,'OFC DI'cTi N/ 34. IV-
35. 02/LPi'l: N, t6. SUCT: 77, NG luBE: N 38. REEP: N 39. FOLEY: N 40. STRYKERT @l
41@ @ICUB: i\l 42. TRACT: N 43. IrtED: N 44. CASTI'@OC: N 45. TRACH: N 46@ MON: N
7i. P'j BAB TYPE@ ND 72. PT BAG TAG .1,@ 73. Pi BAB WT:
47@ SUPP INFO: @4H'@ 27TH ENGINEC,R, IT BRAGS NP REPORTED BY:
SUB AREA JMRO
48@ TAX EN@RTE STOPS: Y 9 49. -MAX '@ RONS: Y / 9 5A@. ALT Rc@s-i/MAX HT: N
53. INPAiic@NT@ Y 54. SPEC PROB: VA DRUG ALCOHOL WI NONE X 55, VA CODE:
56. ADMIN/OVc@RSEAS:
58. VITAL SIGNS(TEMP/PU'@SEIRESPIBLOOD DRESS): 096.6 1 90 / 16 1 138 96
60@ H@T: 61@ ABB: I I DATE TAKEN:
59. F@OB;
62. NBC: 63. SI/VSI: 64. MEDICATIONS: CATEPRESS 4rG @@O BID
65, HISTORY. TWISTING INJUDY L K@IEE, D TFFICUI.T EXT@ @INE L @,NIEE, UNABLE TO WALK
IN.
OR RUN 14/0 PAI@@'.
66. ATT PHYS: WIICKC C, 67. PH#-. 000 000 0000 68. @IAR'u4/PH#: 000 000 000 0000
I @ R@
70. PH4@@ 000 0000
74@ ATTENDANT NAME #I: 7i. STATUS; 76. BRADE:
77. AG---: 78. Sc,X@ 78A. WT: 79. RELATIONSHIP TO PATIENT:
80, BAB TYPE; 8L. BAG TAG O.; 82. BAG WT:
83. ATTENDANT NAME *2. 84. STATUS: 05. GRADE:
96. ABE: 87. SEX. 87A. WT! 68@ RELATIONSHIP TO PATIENT:
87. BAB TYPE- 90. BAG TA'D 91. BAB WI:
92. TRANS ORlro PHONE EXT:
93. TRANS DEST PHONE #t EXT-.
?4@ ETA CIRIG @ITF(DATE/TlriE): 000 95. ETA DEST @ITF(DATE/IIME): 000 1
97. OTHER COMMENTS:
51. IMSN #: 0000/300 52. RON LOC:
57, VALIDATED BY/R@,Ac@ cO.R 416HER PRECEDENCE;
96. AIRCRAFT ITIN'ERARY@ I 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