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File: 102896_aug96_decls2_0016.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
04:39 PATIENT FILE 10/22/90
PERSONAL DATA - PRIVACY ACT OF 1974
5 U.S.C. 552 (b)(6)
13. MODE: A
1. NAME. 18. AUTHORITY 029OA040 2. SSI%N: 3. PRECEDENCE: R
4. STAT: All 5. GRADE: E04 6. AGE: 22Y 7. SEX: N B. WT: 150 9. READY DATE: 290
10. ISO- 11. PBR-. 12. SPEC CAT:
14. REAS REG: DS 15. DATE LAST VISIT: 16. CLASS: 3A
17. ACCEPT PHYS: JMRO 19. ADPT/SURG DATE: NO
20. APPROV AUTH: 21. CANC/INC: 22. VALID: TJH Y6
2,'). MTF GRIS: A5150 USA DISPENSARY DHAHRAN 24. ICM DRIB: GEDR
25. MTF DEST: A5030 FRANKFURT ARMY REG NED 26. ICAD DEST: EDAF
27. MED SPEC 1: SOD 28. DIAS 1: 81000 CLOSED FRACTURE OF CLAVICLE, UNSPECIFIED PART
29. NED SPEC 2: 30. DIAG 2:
31. MED SPEC 3: 32. DIAG 3:
32A. PROCEDURE-
33. SPEC DIET: N/ 34. IV:
35. 02/LPM: N 1 36. SUCT: N 37. NG TUBE: N 39. RESP. N 39. FOLEY: N 40. STRYKER: N
45. TRACH- N 46. MON: N
71. PT BAB TYPE: NB 72. PT BAG TAG 73. PT BAG WT:
47. SUPP INFO- DESERT SHIR D DS: FT BRAGG, NC
48, MAX ENRTE STOPS- Y / 7 49. MAX # RONS: Y / 9 50. ALT REST/MAX HT: N 1
53. INPATIENT: Y 54. SPEC PROB: VA DRUG ALCOHOL WT NONE X 55. VA CODE-
56. ADMIN/GVERSEAS.
58. VITAL SIGNS(TEMP/PULSE/RESP/BLOOD PRESS). 097.5 70 / 18 / 116 66
59. HBB- 60. HCT. 61. ABG- / DATE TAKEN:
62. WBC: 63. SI/VSI: 64. MEDICATIONS: TYLEONL 2 TABS 04H PRN
65. HISTORY: PT W/ FX LEFT CLAVICAL, 17OCT90 WHILE WRESTLING. NEEDS 6-8 WEEKS RE
HAB
66. ATT PHYS- COMPTON 67. PH#: 000 000 0000 68. WARD#/PH#: 000 / 000 000 0000
69. REPORTED BY: A515CrHERRMANSIG 70. PH#. 000 0000
74. ATTENDANT NAME #I: 75. STATUS@ 76. GRADE:
77. AGE- 79. S'LX. 78A. WT- 79. RELATIONSHIP TO PATIENT.
80. BAB TYPE: 81. BAG TAG 82. BAG WT:
83. ATTENDANT NAME #2: 84. STATUS: 85. GRADE:
86. AGE: 87. SEX: 87A. WT: 88. RELATIONSHIP TO PATIENT:
89. BAB TYPE: 90. BAB TAG 91. BAB WT:
92. TRANS CRIG PHONE #z EXT:
93. TRANS DEST PHONE #: EXT,
000 95. ETA DEST KTF(DATE/TIME): 000
97. OTHER COMMENTS:
51. MSN #: 52. RON LOC:
57. VALIDATED BYIREAS FOR HIGHER PRECEDENCE: f
?6. 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