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File: 102896_aug96_decls2_0023.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
05:19 PATIENT FIIF 10/22/90
PERSONAL DATA - PRIVACY ACT OF 1974
5 U.S.C. 552 (b)(6)
13, MODE: A
1. NAME: 18. AUTHORITY 0291@A002 2. SSAN: 3. PRECEDENCE: R
4. STAT-, All 5. GRADE: E06 6. AGE: 36Y 7. SEX: M S. WT-. 170 9. READY DATE: 292
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. CANC/INC. 22. VALID. CLM YI
23. MTF CRIG- A5150 USA DISPENSARY DHAHRAN' 24. ICAD GRIG: GEDR
25. MTF DEST. A5030 FRANKFURT ARMY REG NED 26. ICAD DEST: EDAF
27. NED SPEC 1. SOO 28. DIAS 1: 71783 OLD DISRUPTION OF ANTERIOR CRUCIATE LIGAMENT
29. MED SPEC 2- SOO 30. DIAG 2: 7170 OLD BUCKET HANDLE TEAR OF MEDIA" MENISCUS
31. P@ED SPEC 3- 32. DIAB 3:
32A, PROCEDURE.
M SPEC DIET: N/ 34. IV-
: N
41. INCUB: N 42. TRACT: N 43. IMED: N 44. CASTILOC- N 45. TRACH: N 46. MON: N
71. PT BAB TYPE: NB 72. PT BAB TAG 73, PT BAB WT@
47. SUPP INFO: DESERT SHIELD DS: FT GORDON GA
40. MAX ENRTE STOPS: Y / 9 49, MAX # RONS: Y 1 9 50. ALT REST/tIAX HT: N
53. INPATIENT: Y 54. SPEC PRGG- VA DRUG ALCOHOL WT NONE X 55. VA CODE:
56. ADMIN/GVERSEAS.
58. VITAL SIGNS(TEMP/PULSE/RESPIDLOOD FRESS)- 098.3 1 96 20 110 90
59. H6B: 60. HCT: 61. ABG: DATE TAKEN:
62. WEC- 63. SI/VSI- 64. MEDICATIONS: NONE
65@ HISTORY: PT NEEDS ARTMSCOPE.
66. ATT PHYS: WILCKS 67. PH#: 000 000 0000 69. WARD#/PH#. 000 / 000 000 0000
69. REPORTED BY: A5150/MERCHANTS 70. PR#- 000 0000
74. ATTENDANT NAME #I- 75. STATUS: 76. GRADE,
77. AGE@ 78. SEX: 78A. WT: 79@ RELATIONSHIP TO PATIENT:
80. BAG TYPE. 81. BAG TAG 82. BAG WTt
83. ATTENDANT NAME #2: 94. STATUS. 85, GRADE.
86. AGE@ 87. SEX: 87A. WT: 68. RELATIONSHIP TO PATIENT:
89. BAB TYPE: 90. BAG TAG 91. M WT%
92. TRANS ORIS PHONE EXT:
TRANS DEST PHONE EXT:
94, ETA ORIG MTF(DATE/TIME): 000 95. ETA DEST MTF(DATcl/TIME): 000
97. OTHER COMMENTS:
51. MBN #% 52. RON LOC:
S7. VALIDATED BY/REAS FOR HIGHER PRECEDENCE-
0
,6. AIRCRAFT ITINERARY: 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