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File: 102896_aug96_decls2_0026.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
PATIENT FILE 10/22/90
05:?9
PERSONAL DATA - PRIVACY ACT OF 1974
5 U.S.C. 552 (b)(6)
13. MODE- A
1. NAVtE: 18. AUTHORITY 0293AOOB 2. SSAN- 3. PRECEDENCE- R
4. STAT-. All 5. GRADE: E05 6. AGE: 29Y 7. SEX- M 0. WT- i6O 9. READY DATE: 293
10. ISO: li@ 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. APPRGV AUTH- 21. IANC/INC: 22. VALID: SKO I Y7
23. MTF DRIG- A5150 USA DISPENSARY DHAHRAN 24. ICAD DRIS: DEDR
25. ITF DEST- F5070 USAFRMC WIESBADEN BE 26. ICAO DEST: EDAF
27. MU SPEC I- SOD 29. DIAG 1. 71896 OTHER JOINT DERANGEMENT, NEC INVOLVINB LOWER LEG
29. NED SPEC 2: - 30. DIAG 2:
31, NED SPEC 3-. 32. DIAG 3,.
32A. PROCEDURE:
33, SPEC DIET- NI 34. IV:
35. 02/LPM: N 36. SUCT: N 37. NO TUBE: N 38. RESP: N 39. FOLEY: N 40. STRYKER- N
,ON: N
71. PT BAG TYPE- NB 72. PT BAG TAB 73. PT BAG WT.
47. SUPP INFO- C. CO 314ST IN'F. 15T CAV, FT HOOD, TX REPORTED BY
441H @,ED BOD. ******DS*****
40. MAX ENRTE STOPS: Y / 9 49. MAX # RONS: Y / 9 50. ALT REST/MAX NT,, N
53. INPATIENT. Y 54. SPEC PROS: VA DRUG ALCOHOL WT NONE x 55. VA CODE-
56. ADMIN/GVERSEAS.-
53. VITAL SIGNS(TEMP/PULSEIRESP/BLOOD PRESS): 098.8 48 / 18 I 110 60
59. HGB: 60. HCT: 61. ABB, I DATE TAKEN:
62. WBC. 6'@. SIIVSI: 64. MEDICATIONS- NONE
65. HISTORY. SKIING INJURY L. MEE DEC 89. INSTABILITY SINCE THAT TIME W/ MILD
ETTUSION. NEED ARTHOSCOPY AND CONSIDERATION FOR ACL RECONSTRUCTION.
66. ATT PHYS-. STUART 67. PHI: 000 000 0000 68. WARD#/PH#: 000 / 000 000 0000
69. REPORTED BY: MA@RCHANT 70. PH#- CROO 0000
74. ATTENDANT NAME #I: 75. STATUS- 76. GRADE-
77. AGE: 78. SEX. 78A. WT, 79. RELATIONSHIP TO PATIENT-
60. BAB TYPE- 81. BAG TAG 62. BAB WT.
83. ATTENDANT NAME #2: 84. STATUS: 85. GRADE-,
86. AGE: 87. SEX: 87A. WT. 88. RELATIONSHIP TO PATIENT:
89. BAG TYPE: 90. BAG TAB 91. BAB WT.
92. TRANS ORIG PHONE EXT.
T PHONE EXT:
94. ETA GRIG KTF(DATE/TIME): 000 95. ETA DEST MTF(DATE/TIME): 000
97. OTHER COMMENTS:
51. MBN #: 0000/292 52. RON LOC:
57. VALIDATED BY/REAS FOR HIGHER PRECEDENCE:
96. AIRCRAFT ITINERARY-
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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