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File: 102896_aug96_decls2_0031.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
PERSONAL DATA - PRIVACY ACT OF 1774
5 U.S.C. 552 (b)(6) 13. MODE: A
1. NA14E: 18. AUTHORITY 0293AOO3 2. SSAN: 3. PRECEDENCE: R
4. STAT. All 5. GRADE: E03 6. AGE@ 20Y 7. SEX: K B. WT: 185 9. READY DATE: 292
10, 160: 11, POR: 12. SPEC CAT:
14. REAS REG, DS 15. DATE LAST VISIT: 16. CLASS: 3A
17. ACCEPT PHYS: 19. APPTISURG DATE: Ng
20. APPROV AUTH: 21. CANC/INC: 22. VALID,. I SKO Y7
23. NTF ORIG: A5150 USA DISPENSARY DHAHRAN 24. ICAB DRIG, DEDR
25. MTF DEST: A5030 FRANKFURT ARMY RES NED 26. ICAO DEST: EDAF
27. TIED SPEC 1: MMR 28. DIAG 1: 71697 UNSPECIFIED ARTHROPATHY INVOLVING ANKLE AND FOOT
29. NED SPEC 2-. 30. DIAG 2i
31. MED SPEC 3- 32. DIAS
32A. PROCEDURE:
33. SPEC DIET. N/ 34. IV:
35. 02/LPM: N 36. SUCT- N 37. Ng TUDET N 38. RESP: N 39. FOLEY: N 40. STRYKER-. N
TRACH-. N 46. MON: N
71. PT BAG TYPE-. NB 72. PT BAG TAG 73. PT BAG WT-
47. SUPP INFO- D. CO. 341 INFANTRY DVN. FT. HOOD, TX
*******DS*******
48. MAX ENRTE STOPS. Y / 9 49. MAX # RONS-. Y / 9 50. ALT RESTIMAX HT: N 1
53. INPATIENT: Y 54. SPEC PRGG- VA DRUB ALCOHOL WT NONE X 55. VA CODE:
56, ADMIN/GVERSEAS-.
58. VITAL SIGNS(TEMPIPULSE/RESPIBLOOD PRESS): 097.4 66 1 24 / 119 84
59@ HBB: 60. HCT: 61. ADG- I DATE TAKEN-
62. NBC: 63. SI/VSI@ 64. MEDICATIONS. NONE
65. HISTORY: S/P BUNIGN'ECTOtlY R. GREAT TOE, MARCH 1990, NO@,' W/CDNTINUED PAIN IN
FIRST MTP.
66. ATT PHYS: DR. STUART 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- 76A. WT: 79. RELATIONSHIP TO PATIENT:
80. BAG TYPE- 81. BAG TAG 82. BAG WT:
83. ATTENDANT NAME #2: 84. STATUS: 85. GRADE.
86. A6Ei 87. SEX: 87A. WT: 68. RELATIONSHIP TO PATIENT:
89@ BAG TYPE: 90. BAG TAG 91. BAG WT:
92. TRANS ORIS PHONE EXT-.
97@. TRANS DEST PHONE EXT:
?4. EiA ORIG MTF(DATE/TIME), 000 95. ETA DEST KTF(DATE/TIME): 000
97. OTHER COMMENTS.
51. MSN #: 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