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File: 102896_aug96_decls2_0024.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/??/90
PERSONAL DATA - PRIVACY ACT OF 1974
5 U.S.C. 552 (b)(6)
13. MODE- A
NAME: 18. AUTHORITY 0292AOI7 2. SSAN: 3. PRECEDENCE: R
4. SAT: All 5. GRADE: E05 6. AGE; 27Y 7. SEX-. il S. WT: 203 9. READY DATE: 291
10. ISO: 11, POR: 12. SPEC CAT:
14. REAS REB.- DS 15. DATE LAST VISIT: 16. CLASS: 2D
17. ACCEPT PHYS: 19. AFPT/SURG DATE: NO
20. APPROV AUTH: 21. CANC/INC: 22. VALID. CLM Y7
23. MTF ORIG. A5150 USA DISPENSARY DHAHRAN 24. ICAO GRI6: OEDR
25. MTF DESTT F5070 USAFRMC WIESBADEN BE 26. ICAD DEST: EDAF
27. MED SPEC 1. MMU 28. DIAG 1: 49391 ASTHMA, UNSPECIFIED TYPE, WITH STATUS ASTHMATICUS
29. NED SPEC 2: 7@o. DIAS 2:
31. MED SPEC 3. 32. DIAG 3.
32A. PROCEDURE:
33. SPEC DIET: NI 34. IV:
35. 02/LPH: N 36. SUCT-. N --q. NB TUBE: N 3B. RESP: N 39. FOLEY: N 40. STRYKER, N
46. MON@ N
71. PT BAB TYPE: NB 72. PT BAB TAG 73. PT BAB WT-
47. SUPP INFO-. 1098 TRANS FT EUSTIS, VA
48. MAX ENRTE STOPS: Y 1 9 49. MAX # RQNS- Y / 9 50. ALT REST/MAX HT. N
53. INPATIENT: Y 34. SPEC PROG@ VA DRUG ALCOHOL WT NONE X 55. VA CODE@
56, ADMINIOVERSEAS%
@S. VITAL SIGNS(TEjIP/PULSE/RESP/BLDGD PRESS). 097.6 76 / 2B 136 1 90
59. HGB: 60. HCT: 61. ABG- DATE TAKEN-
62. WBCT 63. SI/VSI, 64. MEDICATIONS: PROVENTGIAL PUFFER 2 PUFFS 0 4HRS
THEOPHYLLIN 250 MG Q 6 HRS.
65. HISTORY: LONG HX OF ASTHMA P2 PROFILE ON USING GAS MASK.
66, ATT PHYS-, ABERT 67. PH#- 000 000 0000 68. WARD#/PH#- 000 / 000 000 0000
69. REPORTED BY: FLOOD 70. PH#: 000 0000
74. ATTENDANT NAME #I: 75. STATUS: 76. GRADE:
77, AGE-. 78. SEX: 78A. WT-, 79. RELATIONSHIP TO PATIENT%
60. BAG TYPE- 81. BAB TAG 82. BAB WT:
83, ATTENDANT NAME #2: 84. STATUS: 85. GRADE:
86. ABE: 87. F-Xi 87A. WT, 88. RELATIONSHIP TO PATIENT.-
89. BAB TYPE-. 90. BAG TAG 91. BAB WT.
92. TRANS DRIG PHONE EXT:
93@ TRANS DEST PHONE EXT:
95. ETA DEST MTF(DATE/TIME); 000
97. OTHER COMMENTS:
51. MSN #: 00011291 52. RON LOC:
57. VALIDATED BY/R"tAS FOR HIGHER PRECEDENCE-
96. AIRCRAFT TTINERARY@
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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