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File: 102896_aug96_decls2_0027.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
05:22 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 0293AOO7 2. SSAN- 3. PRECEDENCE-. R
4. STAT, All 5. GRADE- E04 6. AGE: 21Y 7. SEX, M B. WT: 180 9. READY DATE: 292
10. ISO: 11. PORZ 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: SKO Y7
23. MTF GRIG- A.51o'O USA DISPENSARY DHAHRAN' 24. ICAO GRIG- OEDR
25. MTF DEST: F5070 USAFRMC WIESBADEN GE 26. ICAO DEST: EDAF
27. NED SPEC 1: SSO 2B. DIAS 1. 36400 ACUTE AND SUBACUTE IRIDOCYCLITIS, UNSPECIFIED
29. NED SPEC 2: 30. DIAG 2:
31. NED SPEC 3: 32. DIAG 3-.
32A. PROCEDURE.
33. SPEC DIET: N/ 34. IV-
35. 02/LPM: N 36. SUCT: N 37. NG TUBE: N 38. RESP: N 39. FDLEY. N 40. STRYKER: N
41. INCUB: N 42. TRACT: N 43. IMED: N 44. CAST/LOC. N 45. TRACHT N 46. MON: N
71. PT BAB TYPE: NB 72, PT BAG TAB 73. PT BAG WI:
47. SUPP INFO:
48. MAX ENRTE STOPS-. Y 9 49. MAX # RONS: Y 50. ALT REST/VAX HT: N
53. INPATIENT: Y 54, SPEC PROG: VA DRUB ALCOHOL WT NONE X 55. VA CODE:
56. ADMIN/GVERSEAS-
58. VITAL SIGNS(TEMP/PULSE/RESP/BLODD PRESS): 098.2 68 t 18 / 118 68
59. HGB. 60. HCT: 61. ABG: / DATE TAKEN:
62. WBC: 63. SI/VSI. 64. MEDICATIONST 1% ATROPINE X 1 DROP 3X DAY, 1% PRE
DNISOLONE I DROP TIMES PER DAY
65. HISTORY: 4 DAY HX OF EYE PAIN. REDNESS, LACRINATION AND BLURRED VISIGIN. WO
RSENED ON BASITRACION/N'EGSPDRAN OINTMENT. ADMITTED FOR TREATMENT OF ACUTE UV
EITIS. IMPROVED ON ABOVE MEDICATION. TRANSFERRED FOR OPHTHALMOLOGY EVAL AND
TREATMENT.,
66. ATT PHYS: DUPONT 67. PH#: 000 000 0000 69. WARD#IPH#: 000 / 000 000 0000
69. REPORTED BY: MARCHANT 70. PH#: 000 0000
74. ATTENDANT NAME #I: 75. STATUS. 76. GRADE-
77. AGE: 78. SEX- 78A. WT: 79. RELATIONSHIP TO PATIENT-
80. BAB TYPE: 81. RAG TAG 92. BAG WT:
B@. ATTENDANT NAME #2: 94. STATUS: 85. GRADE:
86. AGE. 87. SEX: 87A. WT. 88. RELATIONSHIP TO PATIENT:
69. BAG TYPE- 90. BAG TAG 91. BAG WT:
EXT.
93. TRANS DEST PHONE EXT:
94. ETA ORIG MTF(DATE/TIME): 000 95. ETA DEST MTF(DATE/TIME): 000
97. OTHER COMMENTS:
51. MSN #: 00001292 52. RON LOC:
57. VALIDATED BY/RBS 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