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File: 102896_aug96_decls2_0021.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
05:04 PATIENT FI[F 10/22/90
PERSONAL DATA - PRIVACY ACT OF 1974
5 U.S.C. 552 (b)(6) 13. MODE: A
1. NAME: 16. AUTHORITY 0291AO76 2. SSAN: 3. PRECEDENCE- R
4, STAT: All 5. GRADE: E03 6. AGE: 19Y 7. SEX; M S. WT: 148 9. READY DATE: 291
10. ISO- 11, POR: I 12. SPEC CAT:
14. REAS REG., DS 15. DATE LAST VISIT: 16. CLASS. 3A
17. ACCEPT PHYS. 19. APPT/SURB DATE- NO
20. APPROV AIJTH. 21. CANCIINC: 22. VALID: f RAG Y6
23. MTF CRIG: A5'50 USA DISPENSARY DHAHRAN 24. ICAU CRIB: OEDR
25. MTF DEST: A5030 FRANKFURT ARMY REG NED 26. ICAD DEST- EDAF
27. MED SPEC 1: MPEA 28. DIAG I.- 30301 ALCOHOL DEPENDENCE, ACUTE INTOXICATION, CONTINUOUS USE
29. NED SPEC 2-. 30. DIAG 2,
31. MED SPEC 3: 32. DIAG 3:
32A. PROCEDURE:
33, SPEC DIET. N/ 34. IV-. 1
-5. 92/LPM.
, N 36. SUCT: N 37. NG TUBE: N 38. RESP: N 39. FOLEY: N 40. STRYRER. N
41. INCUB: N 42. TRACT- N 43. IMED: N 44. CAST/LCC: N 45. TRACH: N 46. MON: N
72, PT BAB TAG 73. PT BAG WT:
47. SUPP INFO: DESERT SHIELD DS: FT BRAGG, NC
48, MAX ENRTE STOPS. Y 1 9 49. VAX # RONS: Y / 9 50. ALT REST/MAX HT: N
53. INPATIENT- Y 54. SPEC PROB: VA DRUG ALCOHOL WT NONE X 55. VA CODE;
56. ADMIN/GVERSEAS:
58. VITAL SAGNS(TEMP/PULSE/RESP/BLOOD PRESt3): 099.4 72 IS / 118 68
@9. HGB: 60, F@CT: 61. ABS: I DATE TAKEN-
62. WBC, 63. SI/VSI: 64. MEDICATIONS: 4
65. HISTORY: PT WI STRONG ALCOHOL DEPENDENCE, HAS EXPERIENCED NO DT'S
66. ATT PHYS: COISON 67. PH#: 000 000 0000 68. WARD#/PH#- 000 / 000 000 0000
69. REPORTED BY- A5150MAR'uHANTEK 70. PH#: 000 0000
74. ATTENDANT NAME #I: 75. STATUS: 76. GRADE:
77. AGE: 78. SEX: 78A. 6'T. 79. RELATIONSHIP TO PATIENT:
80. BAD TYPE: 81. BAG TAG 82. BAG WT:
83. ATTENDANT NAME #2: 84. STATUS: 65. GRADE:
66. AGE: 87. SEX: 87A. WT: 88. RELATIONSHIP TO PATIENT:
69. BAG TYPE: 90. BAG TAG 91. BAB WT:
?2. TRANS DRIG PHONE EXT:
93, TRANS DEST PHONE EXT:
94. ETA DRIS MTF(DATE/TIME)z 000 95. ETA DEST MTF(DATE/TIME): 000
97. OTHER COMMENTS.
. MSN #: 52. RON LOC:
57. VALIDATED BY/REAS FOR HIGHER PRECEDENCE.
96. AIRCRAFT IT INERARY: I 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