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File: 102896_aug96_decls1_0041.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
PATIENT FILE LO/29/90
PERSONAL DATA - PRIVACY ACT OF 1774
1
19. AUTHORITY #: 07OIA010 2@ SSAN: 13. MODE: A
1 3. PRECEDENCE: R
4@ STAT 6. AGE: @5Y 7. SEX: M B. 0,T: 206 9. READY DATE: --,DO
'Lo@ ISO-. 11. POR@ 12. SPEC 0,AT:
14. RE.49 RES: DE 15. DATE LAST VISIT.- 16. CLASS: 3A
'47@ ACCEPT PHYS: 5 U.S.C. 552 (b)(6) 19. APPT/SURG DATE: NO
20. APPROV AUTH: 21. 22@ VALID: rilc@ I Y3
2@. imTF ORIG; A5!50 USA DISPENSARY DHAHRAN 24. I'UAD BRIG: OEDR
2@@, i'@',TF DES7 EDAF
I : A5030 FRANKFURT AR,@Y DES rED 26. ICAG DESTI
27@ M@ED SPEC l@ GOO 28. DIAG 1: 71947 PAIN IN' JOINT INVOLVING ANKLE AND FOOT
2; 30. DIAS 2i
31-. riED SPEC 3: 32, DIAS
@,2A. @OPCCFDURE;
'3@ SPEC D'
ET: N/ 34. IV:
,55. 02/LPI-@ N 36. Su'l@T: @4, 37. NG TUB---: N 39. REEP: N' 39, FOLEY: N 40. STRYKER: N
41= L@NECUB: N 42. TRA IT : N 43. !MED: N 44, CAST/LGC; N 45. TRAC@Q: N 46. MON: N
71. PT BAG TYPE: NB 72, PT BAG TAG 7'Q. PT BAG VJT:
47. SLIPP INFO: 43RD ENGINEER COM.PANY, FT Hgn.D TX
48@ M.4X ENRTE STOPS: Y / 9 4?@ NAX 4 RONS: Y / 9 50. Al-T RcST/MAX HT: N'
53@ INPATIENT: Y 54. SPEC PROS: VA DRUG ALCOHOL @'T @NONC X 55. VA CODE!
56. ADMIN/CVERS'LAS:
5B. VITAL SiGNS'@7EMP/PUI,SEIR@CSPIBLCO'u ORESS): 098.0 60 / 16 / 120 70
59. H@oB. 60. HOT: 61. AEG: DATE TAKEN:
62. NBC i 63. gli'VSI: 64. M;-7D!@@ATTO@A'St MOTRIN 600 ,ITS PO Ti@,
65. HISTO@0,Y- PAIN WI AMBULATION' AND RUNNING PT HAD BURG SEVEN t4@S BEFORE
DEPLOVIENT. POSSIBLE EXPLORATION POSTERIOR TIBULAR N'P-RVE.
66. ATT Pi4YS: t(aLCKERS 67. PH#! 000 0011 0000 68. l@ARD#/PH#: 000 / 000 000 0000
69, REPORTED BY@ H@@'c@IANS 70. PH4: 000 0000
STATUS- 76. GRADE:
77. AGE; 76, S9: 78A. ki; 77. RELATIONSHIP TO PATIEj'iT@
BO, BAB TYPE: 81. BAB TAG 82. BAG WT:
8@ ATTENDANT NAlliE 2-. 84@ STATUS! 63. GRADE:
86@ AGE: 87. SEX-. 87A. WT: 68. RELATIONSHIP TO PATIENT;
89. BAG TYPP-: 90@ BAB TAG 91. BAG WT:
92. TRANS BRIG PHONE EXT:
93. TRANS DEST PHONE EX[:
94. PTA ORIG MTF(DATE/Tls4iE): 000 1 95. ETA DEST @'Fir@@DATE/Tlt',E); 000
97. OTHER CDIMMENITS:
51= LYS)D@ 4: 0000/300 52. RON LO'@:
57. VALIDATED BY/REAS FOR V@IGHFR PREC;-:DFi\'CE;
96. AYRCRAFI !TIi%TRARY@
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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