PATIENT FILE 29 OCT 90

File: 102896_aug96_decls1_0046.txt
Page: 0046
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




             ,17                                                  PATIENT FILE                                              '012919('
                                                    PERSONAL DATA - PRIVACY ACT 0-- '4974



                                                                                                                      13. MODET A
      1.  r@1,;Ii@E:                                       'B. AUTHORITY #: 1)29BA049 2. ESPN:                        3.  PRECEDENCE: R
      4.  STAT:                   A'@' @l, GRADE; Efl,3    6. AGE: 19Y           7, SEYZ iM        S. w!T:    150     9.  READY DATE: 'L98
      io@ 13":                    11. POR:                                                                            12. SPEC CWi:
      14. REAS RES2 DS            15. DATE LAST VISIT:      5 U.S.C.'552 (b)(6)                                       16. CLASS: 2A
      17. ACCEPT P YS:                                                                                                19. APPTISURS DATE: NO
                                  . H
      20. APPROV                  AIJTP,@                                    21. CANCiTNCi                            22. VALID;                  LkiK  Y4
      2 . NTF CRIG. A@,150        USA DISPENSARY DHAHRAN                                                              24, ICA'ul DRIG:   GEDR
      2@@. MTF DEST: A5030        FiANKr:URT APTNW REG -@-ED                                                          26. ICAO DEST:     EDAF
      27. V@'CD SPEC I,. SOO      28. DIAG 1: 82-525   CLOSED FRACTURE- DF   METATARSAL BONE(S)
      29. @'D SPEC 2:             30. 'UIAG 2:
      31. riED SPEC 3@            32. D7AS 'O:
      32A. PROCEDURE:
      33. SPEC DlEi:              I/                                         34. IV@
      ,5, 02/LP@l; N              136. SUCT:   @4      7,7. NIS TLIRE@. N    713. REEP: N                        719. FOI-cly@        N  40. STRYKP,R: N
 CAST/LOCi i%l                  45, TRACH:           N  46. IliON: N
                                                             ED
      71. DT BAG TYPE- iNB                             71,@ PT BAB TAG   @i:                                     73. Fri BAB t4T:
      47@ SU@pp INFO: HONO, HI                                                                          REPORTED BY
      S,'B-AR,'A
      48. PY.AX ENRTE @-TOPSI Y     9                  49@ tiAX 4 ROk!Si Y   1 9                                 50. A,@l R@@STIVAX RT: N
      53. Ir@IPAI-IEN-T: Y        @@4. SPEC PROG:   VA     DRUG      ALCOHOL             NONE X                  55, VA CODE:
      56@ ADMli'@'/OV---.RSEAS@
      58. VITAL STr@
                                  .N'S(-iEMP/PULSE/RESP/BLOOD @@Rc,SS): 099.6  84/20      140      78
      59@ @B@                     60. HOT:             61. ADS:                           I        DATE TA@EN:
      6@'. NBC:                   63. SI/VST!          64. @MEDICATIONS@ %'G'iiE




      65. 'HISTORY- PATIENT INVOLVED la\' VIOTOR VEHlu'LF ACCIDENT 26 SICT 90@ CAST @1,AE APP
      L-"ED 26 GOT 90 ON DOIH. FEET. THEY ARE BI-VA"V;-:Dl








      66@ ATI P,@YS: LCDR THfiR@               67. PH4,:   000 t)00 0000                         68.  NIARD#IPF,#@ 000 / 000 000 0000
      69. REPORT D BY: INIAR@ ANT                                                                70.  PH : 000 0000
                                  ,E @H
      74@ ATTENDAi%ll i'IP@'iE 1:                                                                75@  STATUS:                         76. GRADE:
      77. AC'"t                                76. SEXI               78A.                       79.  RELATTDIN'SHIP TO PATIENT;
      00@ GAS TYPE:                            61. BAB TAG                                       82.  BAG T:
      F6@ ATTENDANT               @iA@-iE #2@                                                    84.  STATUSI                         85. GRADE@
            87A. WT:                   88.  RELATIONSHIP TO PATIENTA
      S9. RAG TYPE;                            90, BAB TAG                                       91.  BAB WI;
      92. TRANS ORIS PHONE                          EXI:
      5ro. TRANS DEST PHONE                         EXTI
      94. ETA N@RIS MTF(DA-'@E/IIME)i 000                                                        95.  ETA DEST i@iTF(DAT@-/TTr@,P-): 000
      97. OTHER COMyi'cNTSt



      51, nN 4: 0000/296                                                                         52. RCFN LC'U:
      57. VALIDATED BY/REA.0@ FOR HIGHER PRECEDENCE:
      96. AIRCRAFT                A
                                  . ., @F,, @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