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File: 102896_aug96_decls2_0012.txt
Subject: PATIENT FILE
Box ID: BX000482
Unit: ARCENT
Parent Organization: CENTCOM
Folder Title: MEDSTAT - SITREPS OCT 90 3 OF 4
Folder SEQ #: 16
Document Number: 6
05435 PATIENT FILE 10/22/90
PERSONAL DATA - PRIVACY ACT OF 1774
5 U.S.C. 552 (b)(6)
13. MODE: A
l@ NAME: 18, AUTHORITY 028BA030 2. SSAN: 3. PRECEDENCE- R
4. ST,4T: All 5. GRADE- E04 6. AGE: 19Y 7. SEX: M B. WT: 160 9. READY DATE. 289
10. ISO-. 11. POR; 12. SPEC CAT:
14. REAS REG: DS 15. DATE LAST VISIT: 16. CLASS: 3A
17. ACCEPT PHYS: JMRO 19. APPT/SURG DATE: NO
20. APPROV AUTH: 21, CANI@/INC: 22, VALID: JRL Y6
23. MTF BRIG: A5150 USA DISPENSARY DHAHRAN' 24. ICAD BRIG: DEDR
25. MTF DESTG A5030 FRANKFURT ARMY REG NED 26. ICAO DEST: EDAF
27. NED SPEC 1: SOD 28. DIAG I-. 82525 CLOSED FRACTURE OF METATARSAL BONE(S)
29. i4ED SPEC 2: 30. DIAS 2:
31. NED SPEC 3: 32. DIAG 3:
32A. PROCEDURE:
33. SPEC DIET- NI 34. IV: I
35. 02/LPM. N 36. SUCT: N 37, NG TUBE: N 38. RESP: N 39. FOLEY. N 40. STRYKER: N
41. INCUB: N 42. TRACT- N 43. IriED: N 44. CAST/LOC: Y I LSL 45. TRACH- N 46. VION- N
71. PT BAG TYPE: NB 72. PT BAG TAG 73. PT BAG WT;
47. SUPP !NFG- DESERT SHIELD DS:FT BLISS, TX
48. MAX ENRTE STOFS- Y / 9 49. MAX 4 RONS: Y 1 9 50. ALT REST/MAX HT: N
53. INPATIENT, Y 54. SPEC PROG: VA DRUG ALCOHOL WT NONE X 55. VA CODE:
@6. ADMIN/GVERSEASi
58. VITAL SIGNS(TEMP/PULSE/RESPIBLOOD PRESS). 097.8 1 54 14 112 80
59. HGB: 60. HCT: 61. ABB: DATE TAKEN-
62. WBC: 63. SI/VSI: 64. MEDICATIONS, N
65. HISTORY: PT W/ FX OF LEFT FOOT, HAS BI-VALVED CAST.
66. ATT PHYS- TUPPER 67. PH#; 000 000 0000 66. WARD#/PH#: 000 / 000 000 0000
69. REPORTED BY: A5150MARCRANTGK 70. PH#: 000 0000
74. ATTENDANT NAME #1@. 75. STATUS: 76. ERADE:
77. AGE: 78. SEX: 78A. WT: 79. RELATIONSHIP TO PATIENT:
80. BAG TYPEI 81. BAG TAG 62. BAG WT.
83. ATTENDANT NAME #2: 84@ STATUS- 85. GRADE:
86. AGE: 87. SEX: 87A. WT: 88. RELATIONSHIP TO PATIENT:
89. BAG TYPE: 90. BAB TAG 91. BAG WT:
92. TRANS BRIG PHONE EXT:
93. TRANS DEST PHONE EXT:
74. ETA BRIG MTF(DATP/TIME): 000 95. ETA DEST MTF(DATE/TIME). 000
97. OTHER COMMENTS:
52. RON LOC-
57. VALIDATED BY/REAS FOR HIGHER PRECEDENCE:
96. AIRCRAFT ITINERARY-
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Document 41 f:/Week-32/BX000482/MEDSTAT - SITREPS OCT 90 3 OF 4/patient file:10019616503518
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
Document Seq # = 6
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