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File: 102896_aug96_decls2_0018.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 **** 10122190
PERSONAL DATA - PRIVACY ACT OF 1974
5 U.S.C. 552 (b)(6)
13. MODE: A
1. NAME: 18. AUTHORITY 0289AOI5 2. SSAN: @ 3. PRECEDENCE: R
4, STAT: All 5. GRADE- E06 6. AGE: 36Y 7. SEX@ M S. WT: 145 9. READY DATE. 289
10. ISO: 11. POR-. 12. SPEC CAT-,
14. REAS REG: DS 15. DATE LAST VISIT: 16. CLASS: 3A
17. ACCEPT PHYS@ JMRO 19. APPT/SURB DATE: NO
20. APPROV AUTH: 21. CANC/INC: 22. VALID- SMP Y7
23. rTF BRIG: A5150 USA DISPENSARY DHAHRAN 24. ICA.0 CRIG: DEDR
MTF DEST: F5070 USAFRMC WIESBADEN BE 26. ICAD DEST: EDAF
27. MED SPEC 1: SOO 23. DIAG 1: 71886 OTHER JOINT DERANGEMENT, NEC INVOLVING LOWER LES
29. MED SPEC 2-, SOO 30. DIAS 2- 71783 OLD DISRUPTION OF ANTERIOR CRUCIATE LIGAMENT
31. NED SPEC 3: 32. DIAG 3:
32A. PROCEDURE-,
33. SPEC DIET: N/ 34. IV:
39. FOLEY- N 40. STRYKER: N
4,. INCUB- N 42. TRACT: N 43. IMED: N 44. CAST/LOC- N 45. TRACH: N 46. MON: N
71. PT BAG TYPE. NB 72. PT BAG TAG 73. PT BAG WT-
47. SUPP INFO: *****DS
****** B CO 7/82ND MAINT FT BRAGG NORTH CAROLINA
48. MAX ENRTE STOFS-. Y 9 49. MAX 4 RONS: Y 1 9 50. ALT REST/MAX HT: N
5.-). INPATIENT: Y 54. SPEC PROB: VA DRUG ALCOHOL WT NONE X 55. VA CODE:
56. ADIIIN/BVERSEAS:
58. VITAL SIGNS(TEMP/PULSE/RESP/BLOOD PRESS): 096@6 60 / 15 / 118 1 58
59, HOB: 60. HCT: 61. ABS: I DATE TAYB-,
62. WBC: 63. SI/VSI: 64. MEDICATIONS: NONE
65. HISTORY:
PATIENT HAS ONE YEAR POST GP ON RIGHT KNEE ACL RECONSTRUCTION. PATIENT THEN
DEVELOPED A 20 DEGREE EXTENDED BLOCK WITH SUFFIENT ANTROPY. PATIENT THEN DIAG
ONGSISED WITH INSTABILITY OF RIGHT EE. PATIENT HAS BEEN EVALUATED AND REFER
RED FOR SURGERY. LAST EVALUATION FOR SURBERY DONE IN AOR 15 OCT
66. ATT P,4YS- WHITT@'@AN 67. PH#: 000 000 0000 60. WARD#/PH#: 000 / 000 000 0000
69. REPORTED BY: 956 DENTON 70. PH#: 000 0000
74. ATTENDANT NAME #I: 75. STATUS. 76. GRADE:
77. AGE-. 78. SEX: 78A. WT: 79. RELATIONSHIP TO PATIENT:
82. BAG WT-
63. ATTENDANT NAME #2- 84, STATUS: 85. GRADE:
86, AGE-. 87. SEX: 87A. WT: 68, RELATIONSHIP TO PATIENT:
89. BAD TYPE- 90. BAD TAG 91. BAG WT:
92. TRANS BRIG PHONE EXT:
93. TRANS DEST PHONE EXT:
94. ETA CRIB MTF(DATE/TIME): 000 95. ETA DEST MTF(DATE/TIME). 000
97. OTHER COMMENTS@
51. MSN #: 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