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File: 102896_aug96_decls2_0013.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
PATIENT FILE 10/22/90
PERSONAL DATA - PRIVACY ACT OF 1974
5 U.S.C. 552 (b)(6)
13. riODE: A
1. NIAME, 18. AUTHORITY 028BA041 2. SBAN: 3. PRECEDENCE: R
4. STAT: All 5. GRADE: EOS 6. AGE-. 39Y 7. SEX: M 8. WT: 195 9. READY DATE: 289
10. ISO@ 11, POR: 12. SPEC CAT:
14. REAS REGI DS 15. DATE LAST VISIT: 16. CLASS- 3A
17. ACCEPT PHYS- JMRO 19. APPT/SURG DATE: NO
20. APPROV AUTH: 21. CANC/INC: 22. VALID: SMF Y6
23. MTF DRIG- A5150 USA DISPENSARY DHAHRAN 24. ICAG DRIG: GEDR
25. MTF DEST: A5040 2ND GEN HOSP LANDSTUHL 26. ICAD DEST: EDAR
27. MED SPEC 1. SO(YL 28. DIAG 1, 7226 DESENERATION OF INTERVERTEBRAL DISC, SITE UNSPECIFIED
z9. MED SPEC 2: 30. DIAS 2:
31, MED SPEC 3: 32. DIAS 3:
32A. PROCEDURE:
33@ SPEC DIET: Mt 34. IV: 1
35. 02/LPM: N 36. SUCT. N 37. NIS TUBE: N 38. RESP- N 39. FOLEY: N 40. STRYKER: N
41. INCUB. N 42. TRACT: N 43. IMED: N 44. CASTILOC: N 45. TRACH: N 46. MON. N
72. PT BAG TAG 73. PT BAG WT-,
47. SUPP INFDT DESERT SHIFID DS: FT BENNING, GA
48. MAX -R4RTE STOPS: Y / 9 49. MAX # RONS: Y / 9 50. ALT REST/MAX HT: N
SL INIPATIENTI Y 54. SPEC PROB: VA DRUG ALCOHOL WT NONE X 55. VA CODE,.
56. ADMIN/CVERSEAS:
58. VITAL SIGNS(TEMP/PULSt7:/RESP/BLCQD PRESS)- 097.0 54 / 16 / 130 1 100
59. HBB: 60. MCI: 61. ADG: I DATE TAKEN:
62. WBC. 63. ST/VSI.- 64. MEDICATIONS. MOTRIN BOOMS OID
65, HISIORY. PT INJURED BACK, JUMPING OUT PLANE 18 YEARS AGO.
66. ATT PHYS: WILKENS 67. PH#- 000 000 0000 68. WARD#/PH#z 000 / 000 000 0000
69. REPORTED BY: Vjl5O/MARTIN/GK 70. PH#: 000 0000
74. ATTENDANT NAME #I: 75. STATUS: 76. BRADE-
77. AGE, 79. SEX: 78A. WT: 79. RELATIONSHIP TO PATIENT:
BO. BAG TYPE: 81. BAG TAG 02. BAG WT:
83. ATTENDANT NAME #2- 84. STATUS: 85. GRADE:
96. AGE: 87. SEX, 87A. WT: 88. RELATIONSHIP TO PATIENT:
89. BAG TYPE: 90. BAB TAG 91. BAG WT-
92. TRANS GRIG PHONE EXT:
93. TRANS DEST PHONE EXT:
94. ETA ORIG MTF(DATE/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