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File: 102896_aug96_decls2_0015.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 10122/90
PERSONAL DATA - PRIVACY ACT OF 1974
5 U.S.C. 552 (b)(6)
13. MODE: A
1. NAME: 18. AUTHORITY 0289AO42 2. SSAN: 3. PRECEDENCE- R
4. STAT-. All 5. GRADE: E04 &. AGE: 35Y 7. SEX: M B. WT: 150 9. READY DATE: 289
10. ISO- 11. POR-. 12. SPEC CAT:
14. REAS REG- DS 15. DATE LAST VISIT: 16. CLASS: 2B
17. ACCEPT PHYS. JMRO 19. APPT/SURB DATE- NO
20. APPROV AUTH: 21. CANC/INIC. ??. VALID: SMF I Y7
2.7. MTF GRIG. A5150 USA DISPENSARY DHAHRAN 24. ICAD GRIG. GEDR
25. MTF DEST: F5070 LISAFRMC WIESBADEN GE 26. ICAD DEST: EDAF
27. MED SPEC I-. BOOM 28. DIAG I-. 2380 NEOPLASM OF UNCERTAIN BEHAVIOR OF BONE & ARTICULAR CARTILAGE
29. MED SPEC 2: 30. DIAG 2t
31. KED SPEC @ 32. DIAS 3:
32A. PROCEDUREZ
33@ SPEC DIET, MI 34. IV:
35. 02/LPM- N 36. SUCT- N ',q. Ng TUBE: N 38. RESP: N 39. FOLEY: N 40. STRYKER: N
N 44. CAST/LDC: N 45. TRACH: N 46. MON: N
71. PT BAG TYPE- ND 72. PT BAG TAG 73. PT BAG WT:
47. SUPP INFO: ******114IST FA, 24TH IMF DIV, FT. STEWART GA*******
48. VAX E@NRTE STOPS. Y / 9 49. MAX # RONS. Y / 9 50. ALT REST/MAX HT: N
53. INPATIENT: Y 54. SPEC PROG: VA DRUG ALCOHOL WT NONE X 55. VA CODE:
56. ADMINIOVERSEAS-.
58@ VITAL SIGNS(TEMP/PULSE/RESPIELOOD PRESS): 099.6 70 / 18 / 110 80
59, HED: 60. MCI- 61. ABB, I DATE TAKEN-
62, WDC. 63. SIIVSI@ 64. MEDICATIONS: MOTRIN SOONG TID
65. HISTORY,. PT WITH 2 TO THREE YRS HX OF KNEE AND ANKLE SWELLING ACCOMPANIED BY
PAIN. X-RAYS SHOW MULTI OSTEOCHONDROMATOSIS. RECOMMEND PT BE EVALED BY ORTH
0 DNIP.DLGGIST.
66. ATT FHYS: GARDNER 67. PH#: 000 000 0000 68. WARD#/PH#: 000 / 000 000 0000
69. REPORTED BY: DENTON 70. PH#: 000 0000
74. ATTENDANT NAME #I: 75. STATUS@ 76. GRADET
77. AGE@ 78, SEX: 78A. WT: 79. RELATIONSHIP TO PATIENTT
80. BAG TYPE- 81, BAG tAG 82. BAG WT:
23. ATTENDANT NAME #2: 84, STATUS: 85. GRADE-
86. ASEZ 87. SEX: 87A. WT: 88. RELATIONSHIP TO PATIENT:
91. BAG WT:
92. TRANS DRIG PHONE EXTT
9@'. TRANS DEST PHONE EXT-
94. ETA ORIG MTF(DATE/TIME): 000 95. ETA DEST MTF(DATE/TIME): 000
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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