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File: 102896_aug96_decls2_0028.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
O@-22 PATIENT FILE 10/22/90
PERSONAL DATA - PRIVACY ACT OF 1974
5 U.S.C. 552 (b)(6) 13. MODE. A
1. NAME: IB. AUTHORITY #-. 029z-4006 2. SSAN.- S. PRECEDENCE: R
4. STAT: All 5. GRADE- E03 6. ABE: 31Y 7. SEX: M B. WT: 200 9. READY DATE: 292
10. ISO: ,I. POR, 1 12. SPEC CAT:
14. REAS RES: DS 15. DATE LAST VISIT: 16. CLASS- 3A
17. ACCEPT PHYS- JMRO 19. APPTISURG DATE: NO
20. APPROV AUTH: 21. CANC/INP@: 22. VALID. SKO Y7
23. MTF CRIG: A5150 USA DISPENSARY DHAHRAN 24. ICAD GRIG- OEDR
25. MTF DEST: F5070 USAFRMC WIESBADEN BE 26. ICAO DEST: EDAC
27. MED SPEC 1: SOD 28. DIAG 1: 7340 FLAT FOOT
29. NED SPEC 2: 30. DIAS 2:
31. MD SPEC 3: 32. DIAS 3-
72A. PROCEDURE,.
33. SPEC DIET. NI 34. IV: 1
35. 02/LPM: N 36. SUCT. N 37. NS TUBE: N 38. RESP: N 39. FOLEY: N 40. STRYKER: N
41. INCUB- N 42. TRACT. N 43. IMED: N 44. CAST/LOC: N 45. TRACH- N 46. MON: N
71. PT BAG TYPE, NB 72. PT BAG TAG 73. PT BAG WT-
47. SUPP INFO@ FT. EUSTIS, VA REPORTED BY
44TH NED BBD *K*vx**DS*******
48. MAX ENRTE STOPS@ Y / 9 49. MAX # RONS: Y 1 9 50. ALT RESTIMAX HT: N 1
53. INPATIENT-. Y 54. SPEC PROG- VA DRUG ALCOHOL WT NONE X 55. VA CODE:
56. ADMINIOVERSEAS:
58. VITAL SIGiNS(TEMP/PULSE/RESP/BLDBD PRESS): 098.6 72 20 / 120 %
59. HBB; 60. HCT: 61, ABS: I DATE TAKEN-
62. NBC: 63. SI/VSI. 64. MEDICATIONS, NONE
65. HISTORY-. PATIENT NEEDS MEDEVAC BACK TO CONUS, FT. EUSTIS, VA FOR MEB. NO REL
IEF OF SYMPTOMS WI TREATMENT TO DATE.
66. ATT PHYS: DALTON 67. FH#: 000 000 0000 69. WARD#/PH#: 000 / 000 000 0000
69. REPORTED BY:' MARCHANT 70. PH#@ 000 0000
74. ATTENDANT NAME #I- 75. STATUS: 76. GRADE:
77. AGE: 78. SEX- 76A. WT: 79. RELATIONSHIP TO PATIENT:
80. BAG TYPE: 81. BAG TAG 82. BAB WT:
97@. ATTENDANT NAME #2: 94. STATUS: 65. GRADE:
86. AGE@ 87. SEX: 87A. WT: 88. RELATIONSHIP TO PATIENT:
89. BAG TYPE. 90. BAG TAG 91. BAG WT:
92. TRANS ORIG PHONE EXT:
93. TRANS DEST PHONE EXT:
94. ETA DRIG MTF(DATE/TIME): 000 95. ETA DEST MTF(DATE/TIME): 000
TS-
51@ @ISN #: 0000/292 52. RON LGC:
57@ VALIDATED BY/REAS FOR HIGHER PRECEDENCE:
96. AIRCRAFT ITINERARY: f 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