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File: 102896_aug96_decls2_0017.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
04:38 PATIENT FI[P '0122/90
PERSONAL DATA - PRIVACY ACT OF 1974
5 U.S.C. 552 (b)(6)
13. MODE- A
1. NAMF-G 18. AUTHORITY 0289AOI3 2. ssill: 3. PRECEDENCE: R
4. STAT: All 5. GRADE. E06 6. AGE: 33Y 7. SEX: M 9. 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 P,4YS.- JMRO 19. APPT/SURB DATE: NO
20. APPROV AUTH: 21. R.ANCIINC: 77. VALID: SMF Y7
23. MTF DRIB, A51@@o USA DISPENSARY DHAHRAN 24. ICAO GRIG- DEDR
25. MTF DEST. F5070 USAFRMC WIESBADEN BE 26. ICAD DEST: EDAF
27. MED SPEC 1: SOD 28. DIAS 1. 71831 RECURRENT DISLOCATION OF JOINT OF SHOULDER REGION
29. MED SPEC 2: 30. DIAG 2.-
31. VRED SPEC 3: 32, DIAG 3.
32A. PROCEDURE:
33, SPEC DIET: N/ 34. IV:
35. 02/LPM: N 36. SUET-. N 37. NG TUBE: N 38. RESP: N 39. FOLEY: N 40. STRYKER: N
41, INCUB: N 42. TRACT: N 43. IMED: N 44. CAST/LDC: N 45. TRACH: N 46. MON. N
: ND 72. PT BAD TAG 73. PT BAG k'T:
47. SUPP INFO: DS HHC 2/ 504TH INF FT BRAGG NC
48. MAX ENRTE 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. ADMIN/DVERSEAS:
58. VITAL SIGNS(TF31P/PULSE/RESPIBLOOD PRESS): 098.6 1 72 / 16 / 130 75
59. HOD-. 60. HCT: 61, ABB- DATE TAKEN:
62. WBC: 63. SI/VSI: 64. MEDICATIONS: TYN 2 TABS 04HRS
65. HISTORY: PT NEEDS VIGOURS REHAB THERADY TWO TO THREE MONTH WITH POSS SURG IN
DIANDSTIC WORK UP NOT AVAIL IN THE AOR
RECCOri RTN TO FT BREAGG NC WACP@ ARRANGE TWO KOLMA OR GETTER ACEPTING PRY
66. ATT PHYS- COMPTON 67. PH#: 000 000 0000 68. WARD#/PH#: 000 / 000 000 0000
69. REPORTED BY: SSG DENTON 70. PH#: 000 0000
74. ATTENDANT NAME #I. 75. STATUS: 76. GRADE:
77. AGE: 78. SEX. 78A. WT: 79. RR ATIOikEHIP TO PATIENT:
80. BAD TYPE: 81. BAG TAG 82. BAG WT.
83, ATTENDANT NAME #2: 84. STATUS- 85. GRADE.-
86. AGE: 87. SEX: 87A. WT: 89. RELATIONSHIP TO PATIENT:
89. BAa TYPE: 90. BAG TAB 91. BAG WT:
92. TRANS ORIG PHONE EXT@
93. TRANS DEST PHONE EXT:
000 95. ETA DEST MTF(DATEITIME): 000
97. OTHER COMM24TS:
5'@. MSN #: 52. RON LOC:
57. VALIDATED BY/REAS FOR HIGHER PRECEDENCE.
96. AIRCRAFT ITINERARY: I f
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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