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File: 102896_aug96_decls1_0043.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:@13:56 PATIENT FILE 10129190
PERSONAL DAT - PRIVACY AP] OF '974
,A
13. i@,ODE: A
l@ NAME B. AUTHORITY #: 03OIA013 2. SSA@NI: m 3. PRECEDENCE: R
4. STAT; U,-tHuri Lv, 6, AGE: 22Y 7@ SEX; S. WT: 'AO 9. READY DATE: 300
io, LSD, 11. POR: 12. SPEC CAT:
14. REAS RES: DS 15. DATE LAST VISIT: 5 U.S.C. 552 (b)(6) 16. CLASS: 3A
17@ ACCEPT 19. APPT/SURG DATE: NO
2A. AT-PROV ALITH@ 'Ll. CAN'U/INCi 22. VALID: I M'@E I Y7
2'o, eiTF ORI@ A5150 USA DISPENSARY DHAHRAN 1.4. ICAD OR16t OEDR
?-5@ MTF DEST-. A5030 FRANKFURT ARMY Rc @.-ED 26. ICAG DEST: EDAF
47. M@@D SPEC 1: SOD 28@ DIAS 1: 7242 LUMBAGO
29. SPEC 2: -@0. DIAS 2:
@l;
32A@ PROCEDURE;
33. SPEC DIE@: N/ 34. IV@
,5. 02/LP,'!: N 36. SLICT: i\i 7,7, Nick TUBE: N 38. RESP: N
39. FOLEY: @@l 40. STRYKER: N'
41@ !NCUB: N 42. TRACT: N 43. TVIED: N 44. CAST/LG'@@ N 45. TRA'@H: N 46. tiON: N
7'. PT BAG TYPE: NB 72. PT BAG TAG 73. PT BAB WT:
47. SUPP 664TH ORDINANCE CG,4'iPA,\'Y, FT BRAGS NO
**,'DS******
48. MAX EINR-[E SIOPS@, Y / 9 49. MAX # ROXIS: Y 1 9 50. ALT RESTIMAX HT: iN
S-). INPATIENIT@ Y 54. SPEC PRO,'-: VA DRUG ALCOHOL Vi NONE X 55. VA CODE:
@6, AD,@,ItN/OVc@RSEAS:
52. VII.A'@ STGNIG(TEMPI@E"' 87n/RESPIBLLIOD PRESS): 097.0 80 / 12 1 120 70
59@ HOB: 60. @4CT; 61. AEG: I I I DATE TAKEN:
62@ NBC: 63. SIIVSI@ 64, MEDICATIONS! NONE
6@@@ HISTORY: 'uROMI@, BACK PAli%', HAS NOT Pcls:PONDED TO MEDICATIONS CR PHYSICAL
THERAPY, @7ST OF LO'AER BACK PAIN X 1YR.
I 1
66. A TYg- tkITI C SS 67@ PF, : 000 00r, 0000 68. 1,4ARD#/PH#: 000 / 000 000 0000
70@ PH#: 000 0000
74. ATTENDANT NAME 41: 75. STATUS: 76. BRAD-a:
77@ AG--t 78@ SEX, 76A.. N-i: 79, RELATIONSHIP TO PATIENTI
90@ BAB TYPE: 81. BAG TAG t?: 82. BAG NT:
B@ ATT KIDANIT NAME #2: 84. STATUS: 85@ GRADE:
86. AGE2 67. SE'AA 87A. @-,'T. 88. RELATIONSHIP TO PATIENT:
89@ BAB TYPE: 90. BAB TAG 91. BAG @IT;
92@ TRANS ORTS PHONE -@T;
7Z. TRANS DEST PHONE O,' EXT:
94. ETORIG '.IT;:@DATE/TIM@): 000 1 95. ETA DEST MTF(DATE/TIME)i 000
@A I 1
97= OTHER COi'IMENTS@
5'@ M@SN #-. 0000/700 52. RON LOC:
57. VALIDATED BY/REAS FOR HIGHER PRECEDENCE:
96. AIRCRAFT ITINERARY: II 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