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File: 102896_aug96_decls2_0014.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
05:34 PATIENT FILE 10/22/90
PERSONAL DATA - PRIVACY ACT OF 1974
5 U.S.C. 552 (b)(6)
13. MODE: A
1. NAME: 10. AUTHORITY 02BOA037 2. SSAN: 7. PRECEDENCE: R
4. STAT: Ail 5. GRADE. E04 6. AGE: 25Y 7. SEX-. M B. WT. 176 9. READY DATE: 289
10. ISO. 11. POR: 12. SPEC CAT:
14. REAS REG: DS 15, DATE LAST VISIT-. 16. CLASSI 3A
17. ACCEPT PHYS: J?,RG 19. APPT/SURB DATE: NO
20. APPROV AUTH: 21. CANC/IRC: ??. VALID: SMF Y6
23. MTF ORIS: A5150 USA DISPENSARY DHAHRAN 24. ICAO CRIG: GEDR
25. MTF DEST: A5040 2ND GEN HOSP LANDSTUH" 26. ICAD DEST: EDAR
27. NED SPEC 1: 800 28. DIAS I,. 81381 FRACTURE OF UNSPECIFIED PART IF RADIUS (ALONE), CLOSED
29, NED SPEC 2: SOO 30. DIAG 2; 81401 CLOSED FRACTURE OF NAVICULAR (SCAPHOID) DONE OF WRIST
31. t4ED SPEC 3: 32. DIAG 3:
32A. PROCEDURE;
33. SPEC DIET: N/ 34. IV,
35. 02/LPi4: N 36. SUCT, N 7@7. Ng TUBE: N' 38. RESP: N 19. FOLEY- N 40, STRYKER: N
44. CAST/LOC: Y / LA 45. TRACH: N 46. MON., N
71. PT BAB TYPE. MB 72. PT BAG TAG 73. PT BAG WT-
47. SUPP INFO: DESERT SHIELD DS@ FT STORY, VA
46. MAX ENIRTE STOPS., Y / 9 49. MAX # RONS: Y 1 9 50. ALT REST/MAX RT. N
53. INPATIENT-. Y 54. SPEC PROG- VA DRUG ALCOHOL WT NONE X 55. VA CODE:
56. ADMIN/GVERSEAS-
58. VITAL SIGNS(TEMP/PULSE/RESP/BLGOD PRESS): 097.4 82 16 132 82
59, HBB: 60. HCT: 61. AEG: DATE TAKEN:
62. WBC: 63. SI/VSI: 64. MEDICATIONS- N
6@@. HISTORY: PT FELL DOWN.
66, ATT PH.YS-. WILKENS 67. PH#: 000 00t) 0000 68. WARD#/PH#: 000 / 000 000 0000
b9. REPORTED BY: A4'150/M@ARTINIGK 70. PH#: 000 0000
74. ATTENDANT NAME #I: 75. STATUS: 76. GRADE:
77. AGE, 79, SEX: 78A. WT: 79. RELATIONSHIP TO PATIENT-.
90. BAG TYPE: 81, BAG TAG 82. BAG WT:
63. ATTENDANT NAME #2: 84, STATUS: B5. GRADE-
86. AGE- 87. SEX- 87A. WT: 88. RELATIONSHIP TO PATIENT:
89. BAG TYPE: 90. BAG TAG 91. BAG WT:
92. TRANS ORIG PHONE EXT@
93. TRANS DEST PHONE EXT,
94. ETA DRIG KTF(DATE/TIME): 000 95. ETA DEST MTF(DATE/TIME): 000
MMENTS:
51. MSN #- 52. RON LDC:
57. VALIDATED BY/REAS FOR HIGHER PRECEDENCE:
96. AIRCRAFT ITINERARY: I
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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