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File: 102896_aug96_decls2_0022.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
05-17 PATIENT FILE 10/22/90
PERSONAL DATA - PRIVACY ACT OF 1974
5 U.S.C. 552 (b)(6)
3. MODE. A
1. NAME: 18. AUTHORITY 0292AOI9 2. SSAN:md3. PRECEDENCE: R
4, STAT: All 5. GRADE: E06 6. AGE- 26Y 7. SEX- M B. WT. 154 9. READY DATE: 291
10. ISO- 11. POR: 12. SPEC CAT:
14. REAS REG: DS 15. DATE LAST VISIT: 16. CLASS: 3A
17. ACCEPT PHYS: JMRO 19. APPT/SURG DATE: NO
20. APPROV AUTH: 21. P@ANC/I'iC- 22. VALID: CLM Y7
23. MTF GRIG: A5150 USA DISPENMRY DHAHRAN 24. ICAD GRIG: DEDR
25. MTF DEST. A5030 FRANKFURT ARMY REG NED 26. ICAD DEST: EDAF
27. MED SPEC 1: SSE 26. DIAG 1: 55091 INGUINAL HERNIA NOS, UNILATERAL OR UNSPECIFIED, RECURRENT
29, MED SPEC 2- 30. DIAS 2:
31. ?,ED SPEC 3: 32. DIAG 3:
',K2A. PROCEDURE-
33. SPEC DIET: N/ 34. IV-,
'5. 02/LPM.
- N 36. SUCT: N 37. NG TUBE: N 39. RESP: N 39. FOLEY. N 40. STRYKER: N
N 42. TRACT@ N 43. IMED: N 44. CAST/LOC: N f 45. TRACH. N 46. MON: N
71. PT BAG TYPE: NB 72. PT BAG TAG 73. PT BAG WT:
47. SUPP INFO, HHT 4/17TH CAV; FT. CAMPBELL, KY REPORTED BY
44TH r@cD BDE/28 CSH
48. MAX ENRTE STOPS: Y / 9 49. MAX # 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. ADiMIN/GVERSEAS@
58. VITAL SIGNS(TEiMP/PULSE/RESP/BLDOD PRESS): 098.2 60 / 20 / 110 80
59. HBB: 60, HCT: 61. ADG: DATE TAKEN-.
62. WDC: 63. SI/VSI: 64. MEDICATIONS: NONE
65, HISTORY: PT IS S/P HERNIA REPAIR - 1984. PT FELT A RECURRENCE OF HERNIA WHIL
E LIFTING A FUEL BLADDER X3WEEKS. PT NEEDS A/E FOR POSSIBLE MARLEX MESH REPAI
R AND EXTENDED CONVALESCENCE.
66. ATT PHYS: BEAM 67. PH#@ 000 000 0000 68. WARD#/PH#- 000 / 000 000 0000
69. REPORTED BY: DENTON 70. PH#: 000 0000
74. ATTENDANT NAME #I- 75. STATUS: 76. GRADE:
77. AGE: 70. SEX-. 70A. WT: 79. RELATIONSHIP TO PATIENT:
80. BAG TYPE: 81. BAG TAG 82. BAG WT-
63. ATTENDANT NAME #2: 04. SIATUS: 85. GRADE:
88. RELATIONSHIP TO PATIENT:
69. EPro TYPE: 90. BAG TAB 91. BAG WT:
92. TRANS GRIG PHONE EXT;
93. TRANS DEST PHONE EXT,
94. ETA ORIG KTF(DATE/TIME): 000 1 95. ETA DEST MTF(DATE/TIME)t 000
97. OTHER COMriENTS-
51. MSN #: 00011291 52. RON LOC:
57. VALIDATED BY/REAS FOR HIGHER PRECEDENCE:
96. AIRCRAFT ITINERARY- I I 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