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File: 102896_aug96_decls2_0030.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 m*x* 10/22/90
PERSONAL DATA - PRIVACY ACT OF 1974
5 U.S.C. 552 (b)(6) 13. MODE. A
3. PRECEDENCE: R
NAME-. 18. AUTHORITY 029SA004 2. SSAN-.
4. STAT: All 5. GRADE: E04 6. AGE: 23Y 7. SEX: M S. WT: 160 9. READY DATE. 292
10. ISO-. 11. POR. 12. SPEC CAT:
14. REAS REG: DS 15. DATE LAST VISIT- 16. CLASS: 2B
17. ACCEPT PHYS: JMRO 19. APPT/SURG DATE: NO
20. APPROV AUTH: 21. CANC/INC: 22. VALID- I SKO Y7
23. hTF BRIG- A5150 USA DISPENSARY DHAHRAN 24. ICAD BRIG- DEDR
25. MTF DEST: F5070 USAFRMC WIESBADEN BE 26. ICAD DEST: EDAF
27. NED SPEC 1. MMU 28. DIAS I,. 86121 CONTUSION OF LUNG WITHOUT OPEN WOUND INTO THORAX
29. NED SPEC 2: SOD 10. DIAS 2. 80710 OPEN FRACTURE OF RIB(S), UNSPECIFIED
31. MED SPEC 3,. 32. DIAG 3:
32A. PROCEDURE:
3-3. SPEC DIET: N/ 34, IV:
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 BAB TYPE. M 72. PT BAG TAB 73. PT BAB WT:
47. SUPP INFO:
48. MAX ENRTE STOPS: Y 9 49. MAX # RONS: Y / 9 50. ALT REST/MAX HT: N
53. INPATIENT: Y 54. SPEC PROB: VA DRUG ALCOHOL WT NONE X 55. VA CODE-
56. ADMIN/OVc@RSEAS:
58. VITAL SIGNS(TEMP/PULSE/RESP/BLOOD PRESS): 098.7 1 65 / 18 / ilO 60
59. HSB: 60. HCT- 61. ABB: I I DATE TAKEN:
62. WBC-, 63. SI/VSI: 64. MEDICATIONS: TYLENOL 3 PRN
65. HISTORY: CRUSHED BY FORK LIFT ON 12 OCT.
66. ATT PHYS: THOMPSON 67. PH#: 000 000 0000 68. 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: 78A. 6'T- 79. RELATIONSHIP TO PATIENT.
80. BAB TYPE: 81. BAB TAG 82. BAB WT:
93. ATTENDANT. NAME #2: 84. STATUS. 65. GRADE:
88. RELATIONSHIP M PATIENT:
89. BAB TYPE. 90. BAG TAG 91. BAG WT:
92. TRANS ORIG PHONE EXT:
97@. TRANS DEST PHONE EXT-
94. ETA GRIG iMTF(DATE/TIME): 000 95. ETA DEST MTF(DATE/TIME)-, 000
97. OTHER COMMENTS:
51. IMSN #: 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