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File: 102896_aug96_decls2_0029.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. N!.Ar@r@, 18. AUTHORITY 0293AOO5 2. SSAN. 3. PRECEDENCE: R
4. STV,: All 5. GRADE: E03 6. AGE: 23Y 7. SEX: M B. WT: 150 9. READY DATE: 292
110. ISO: 11. POR- 12. SPEC CAT-
14. REAS REG: DS 15. DATE LAST VISIT: 16. CLASS: 3A
17. ACCEPT PHYS- 19. APPT/SURB DATE: KID
20. APPROV AUTH-. 21, CANC/INC: 22. VALID: SKO Y7
23. MTF GRIG: A5150 USA DISPENSARY DHAHRAN 24. ICAD CRIB: GEDR
25. @MTF DEST: A5030 FRANKFURT ARMY REG MED 26. ICAG DEST: EDAF
27. NED SPEC 1: SOP 28. DIAG 1: 7271 BUNION
29. MED SPEC 2-@ 30. DIAG 2.
31, MED SPEC 3@ 32. DIAG 3:
32A. PROCEDUREI
. SPEC DIET: N/ 34. IV.
35. 02/LPM.- N 36. SUCT: N -@7. NS TUBE: N 36. RESP-. N 39. FOLEY-. N 40. STRYKER: N
. CAST/LOC, N 45. TRACH: N 46. MON: N
71@ PT BAG TYPE- NB 72. PT BAB TAG 73. PT BAG WT:
47. SUPP INFO. 567TH TRANS, FT. EUSTES, VA REPORTED BY
44TH MED BGD ******DS******
49. MAX ENRTE STOPS: Y / 9 49. MAX # RO@NS. Y / 9 50. ALT REST/MAX HT: N
Y@. INPATIENT: Y 54. SPEC PROG-. VA DRUG ALCOHO, WT NONE X 55. VA CODE:
56. ADMIN/GVERSEAS:
58. VITAL SIBNS(TEriP/PULSE/RESP/BLOOD PRESS). 078.8 72 / IS / 100 70
59. HBB: 60. HCT: 61. ABS: DATE TAREN-,
62. NBC: 63. SI/VSI: 64. MEDICATIONS: NONE
65. HISTORY. BILATERAL PAINFUL FEEI FOR EIGHT MNONTHS, HAS MULTIPLE PLANTER WART
S ON HEELS, REQUIRES TREATMENT.
66. ATT PHYS: STUART 67. PH#: 000 000 0000 68. WARD#/PH#: 000 / 000 000 0000
69. REPORTED BY. MARCHANT 70. PP.#: 000 0000
74, ATTENDANT NAME #1-. 75. STATUS: 76. GRADE:
77. ASET 78. SEX: 78A. WT- 79, RELATIONSHIP TO PATIENT-.
00. BAG TYPE- 81. BAG TAG 82, BAG WT-
83. ATTENDANT NAME #2: 84. STATUS: 85. GRADE.
86. AGE: 87. SEX: 87A. WT: 88. RELATIONSHIP TO PATIENT:
AB 91. BAG WT:
72. TRANS GRIO PHONE EXT:
93. TRANS DEST PHONE EXT-
94. ETA GRIS MTF(DATE/TIME): 000 1 95. ETA DEST MTF(DATE/TIME)- 000
97. OTHER COMMENTS:
5'@. MSt4 #. 0000/292 52. RON LOC:
57. VALIDATED BY/REAS FOR HIGHER PRECEDENCE:
%. 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