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File: 102896_aug96_decls2_0025.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)
13. MODE: A
1. NAME: 18. AUTHORITY 02924018 2. SSAN: m 3. PRECEDENCE: R
4. STAT; All 5. BRADE-. E04 6. AGE: 24Y 7. SEXT M S. WT: 190 9. READY DATE: 291
10. ISO- 11. POR-. 12. SPEC CAT:
14. REAS REG., DS 15. DATE LAST VISIT: 16. CLASS: 2B
17. ACCEPT PHYS- 19. APPT/SURG DATE: NO
20. APPROV AUTH: 21. CANC/INC: 22. VALID. CLM Y7
23. KTF ORI6. A5150 USA DISPENSARY DHAHRAN 24. ICAB DRIG: GEDR
25. MTF DEST: F@@070 USAFRMC WIESBADEN GE 26. ICAG DEST: EDAF
27. VIED SPEC 1: MilU 28. DIAG I- 49391 ASTHMA, UNSPECIFIED TYPE, WITH STATUS ASTHMATICUS
29. MED SPEC 2: 30, DIAG 2-
31. NED SPEC 3: 32. DIAS 3:
32A. PROCEDURE-,
33. SPEC DIET. N/ 34. IV:
35, 02/LPM: N 36. SUCT- N 37, NG TUBE: N 38. RESP- N 39. FOLEY: N 40i STRYKER: N
: N 44. CAST/LDC-. N 45. TRACH. N 46. MON: N
71. PT BAB TYPE- NB 72. PT BAB TAG 73, PT BAB 14T-
47. SUPP INFG- 332ND ARMOR; leri CAV FT. HOOD, TX
49. MAX ENRTE STGPS: Y / 9 49. MAX # RONS: Y 1 9 50. ALT REST/MAX HT: N
53. INPATIENT: Y 54. SPEC PRDB: VA DRUG ALCOHOL 'AT NONE X 55. VA CODE:
56. ADMINIOVERSEAS-
58. VITAL SIGNS(TEMP/PULSEIRESP/BLOOD PRESS): 099.0 60 / 20 1 120 80
59. HGBT 60. HCT: 61. ABS: I DATE TAKEN:
62. Wj'@@ 63. SI/VSI. 64. MEDICATIONS- BECONASE NASAL INHALER BID/ALBUTROL
INHALER .2MG 2CC NS OHRS/THEODUR 300MG BID
65. HISIORY: PT HAS WORSENING ASTHMA & MAXILLARY SINUSITIS. PT FOLLOWED CLOSELY
BY ALLERGIST AT HOME STATIGIN.
66. ATT PHYS: WUCKICH 67. PH#: 000 000 0000 68. WARD#/PH#: 000 / 000 000 0000
69. REPORTED BY: SSG DENTON 70. PH#. 000 0000
74. ATTENDANT NAME #I-. 75. STATUS: 76. GRADE.
77. AGE: 76. SEX: 76A. WT: 79. RELATIONSHIP TO PATIENT:
80. BAG TYPE: 81. DAG TAB 82. BAB WT:
&3. ATTENDANT NAME #2. 84. STATUS- 85. GRADE:
86. AGE: 87. SEX. 87A. WT. 98. RELATIONSHIP TO PATIENT:
69. BAG TYPE: 90. BAG TAG 91. BAG WT-
92. TRANS ORIS PHONE EXT.
93, TRANS DEST PHONE EXT:
94. ETA ORIG ViTF(D.4TE/TIME): 000 1 95. ETA DEST MTF(DATE/TIME): 000
97. OTHER COMMENTS:
5i. MBN #: 0001/291 52. RON LOCI
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