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File: 102896_aug96_decls2_0032.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
05:23
PERSONAL DATA - PRIVACY ACT OF 1974
5 U.S.C. 552 (b)(6) 13. MODE: A
1. NAME: 18. AUTHORITY 0273AOO2 2. SSAN@ 3. PRECEDBCE- R
4. STAT-. All 5. GRADE- E05 6. AGE: 31Y 7. SEX, M B. 4T: 130 9. READY DATE. 292
10. ISO: 11, POR. 12. SPEC CAT-. 1
14. REAS REG: DS 15. DATE LAST VISIT: 16. CLASS. 3A
17. ACCEPT PDYS- JMRO 19. APPT/SURB DATE: NO
20. APPROV AUTH: 21. CANC/INC: 22. VALID: I SKO Y7
2@'. MTF DRIG: A5150 USA DISPENSARY DHAHRAN 24. ICAD BRIG: OEDR
25. MTF DEST: F5070 USAFRMC WIESBADEN GE 26. ICAO DEST- EDAF
27. NED SPEC 1: MMI 28. DIAG 1: 2892 NONSPECIFIC NESENTERIC LYMPHAD@CNITIS
29. NED SPEC 2. 30. DIAG 2i
31. NED SPEC 3: 32. DIAG 3:
32A. PROCEDURE:
33. SPEC DIET- NI 34. IV:
35. 02/LPM: N 36. SUET: N 7@7, NS TUBE: N 38. RESP: N 39. FOM: N 40. STRYKER- N
N
71. PT BAG TYPE- ND 72. PT BAG TAG 73. PT BAB WT-.
47. SUPP INFO: A CO. 50TH SIGNAL, IBTH AIRBORN, FT, BRACE, NC
,8@ MAX RTE STOPS: Y / 9 49. MAX # RONS- Y / 9 50. ALT REST/MAX HTt N
53. INPATIENT. Y 54. SPEC PROB: VA DRUG ALCOHOL WT NONE X 55. VA CODE:
56. ADMIN/GVERSEAS.
58. VITAL SIGNS(TEMP/PULSE/RESP/BLOOD PRESS): 098.6 / 72 1 16 1 130 70
59. HGB: 60. P@CT- 61. ABG- I DATE TAKEN:
62. WBC- 63. SI/VSI: 64, MEDICATIONS: TYLENOL 3 1 OF 2 PO 4-6 HRS PRN
65. HISTORY. SEVERE BASTROENTERITIS, ACUTE ABDOMINAI PAIN' REQUIRING EXPLORATORY
SURGERY.
66. ATT PHYS: DR.(MAJ)BUTE 67. PH#: 000 000 0000 60. 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: 7BA. WT: 79. RELATIONSHIP TO PATIENT-
80. BAB TYPE: 81. BAG TAG 82. BAG @IT:
83. ATTENDANT NAME #2: 84. STATUS: 85. GRADE-
86. AGE: 87. SEX: 87A. WT@ 80. RELATIONSHIP TO PATIENT:
99. BAG TYPE: 90. BAG TAG 91. BAB WT:
92. TRANS OR TS PHONE EXT:
93. TRANS DES, PHONE EXT:
94. ETA BRIG MTF(DATE/TIME): 000 95. ETA DEST MTF(DATE/TIME): 000
97. OTHER COMMENTS:
51, MSN #: 0000/292 52. RON LOC-
57. VALIDATED BY/REAS FOR HIGHER PRECEDENCE:
96. AIRCRAFT ITINERARY: I f
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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