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File: 102896_aug96_decls2_0019.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 FILE **** 10/22/90
PERSONAL DATA - PRIVACY ACT OF 1974
5 U.S.C. 552 (b)(6)
13. MODE: A
1. NAME: 18. AUTHORITY 0289AOI6 2. SSAN: 3. PRECEDENCE: R
4. STAT: All 5. GRADE: 003 6. AGE: 2BY 7. SEX@ M B. WT: 210 9. READY DATE: 289
10. ISO@ 11, POR: 12. SPEC CAT:
!4. 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. SMF Y7
23. MTF CRIB- A5150 USA DISPENSARY DHAHRAN 24. ICAU ORIG: GEDR
25. MTF DEST: F5070 USAFRi4C WIESBADEN GE 26. ICAO DEST-. EDAF
27, MED SPEC 1: SOD 28. DIAG 1. 71836 RECURRENT DISLOCATION OF LOWER LEG JOINT
29. NED SPEC 2., SOO 30. DIAS 2- 71986 OTHER JOINT DERANGEMENT, NEC INVOLVING LOWER LEG
31. MED SPEC 3: 32. DIAS 3:
32A. PROCEDURE:
33, SPEC DIET: N/ 34. IV:
35. 02/LPM: N 36. SUCT- N 37. NS TUBE: N 38. RESP. N 39. FOLEY: N 40. STRYKER: N
44. CAST/LGC: N 45. TRACH: N 46. MON: N
71, PT BAG TYPE-. ND 72. PT BAG TAG 73. PT BAG WT.
47. SUPP INFO: *****DS**** HHB 82ND AIR BORN FT BRAGG NORTH CAROLINA
48. MAX ENRTE STOPS: Y 1 9 49. MAX # RONS: Y 1 9 50. ALT REST/MAX HT: N
53. INPATIENT: Y 54. SPEC PROG: VA DRUG ALCOHOL WT NONE X 55. VA CODE:
56. ADMIN/GVERSEAS:
@8. VITAL SIGNS(TEMP/PULGE/RESP/BLOOD PRESS), 098.4 f 00 / 16 / 120 66
59. HGB. 60. RCT: 61. ABG- DATE TAKEN:
b2. WBC: 63. SI/Vgl: 64. MEDICATIONS: NONE
65. HISTORY:
PATIENT HAS FREQUENT REOCCURRENCE OF LEFT KNEE INSTABILITY. PATIENT HAS BEEN
DIAGNOSED WITH ACL DIFF RIGHT KNEE, WHICH REQUIRES SURGERY AND SIX TO EIGHT M
ONTHS REHABILITATION. DR KOUBA OR DR BETTER AT WOMACK ARMY COMMUNITY HOSPITAL
WILL ACCEPT PATIENT.
66, ATT PHYS: COSTEN 67. PH#: 000 000 0000 66. WARD#/PH#: 000 I 000 000 0000
69. REPORTED BY: 556 DENTON 70. PH#: 000 0000
74. ATTENDANT NAME #I: 75. STATUS: 76. GRADE:
77. AGE: 78. SEX: 78A. WT, 79. RR ATIONSHIP TO PATIENT:
80, BAG TYPEI 81. BAG TAG 82. BAS WT:
83. ATTENDANT NAME #2: 84. STATUS: 85. GRADE:
86. AGE: 87. SEX: 87A. WT: 88. RELATIONSHIP TO PATIENT'
91. BAS WT:
92. TRANS GRIG PHONE EXT:
93. TRANS DEST PHONE EXT:
94. ETA GRIG MTF(DATE/TIME): 000 95. ETA DEST MTF(DATE/TIME): 000
?7. OTHER COMMENTS-.
51. MSN #: 52. RON LGC-
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