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File: 102896_aug96_decls2_0033.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
05-23 PATIENT FILE 10/22/90
PERSONAL DATA - PRIVACY ACT OF 1974
5 U.S.C. 552 (b)(6)
13. ?IDDE: A
1. NAME-. 18. AUTHORITY 0293AOOI 2. SSAM. 3. PRECEDENCE-. R
4, STAT: All 5. GRADE: E04 6. AGE: 31Y 7. SEX: F S. WT: 125 9. READY DATE: 292
10. ISO: 11. POR: 12. SPEC CAT:
14. REAS REG., DS 15. DATE LAST VISIT: 16. CLASS-. 3A
17. ACCEPT P,4YS: 19. APPT/SURG DATE.- NO
20. APPROV AUTH: 21. CANCIINC. 22. VALID- I SKO I Y7
23. rTF GRIG: A5150 USA DISPENSARY DHAHRAN 24. ICAD ORIS: GEDR
25. rTF DEST. F5070 USAFRMC WIESBADEN BE 26. ICAD DEST,. EDAF
27. IMED SPEC 1: 6% 28. DIAS 1: 2169 LEIGMYOMA OF UTERUS, UNSPECIFIED
29. TIED SPEC 2, SSG 30. DIAG 2@ 6253 DYSMENORRHEA
31. MED SPEC 3-. 32, DIAS 3:
32A. PROCEDUREI
33. SPEC DIET: N/ 34. IV@
35. 02/LPM- N 36. SUCT: N -)7. NG TUBE: N 39. RESP: N 39. FOLEY: N 40. STRYKER: N
ACHI N 46. MON: N
71. PT BAB TYPE: NB 72. PT BAB TAG 73. PT BAB WT,.
47. SUPP INFO: 5TH MASH, FT. BRAGG, NC REPORTED BY:
44TH V@ED BOD xx*xx*DS*****
48. MAX ENRTE STOPS: Y / 9 49. MAX # RGNS-. Y / 9 50. ALT REST/iMAX HT: N
53. INPATIENT, Y 54, SPEC PROG- VA DRUB ALCOHOL WT NONE x 55. VA CODE:
56. ADriIN/GVERSEAS-.
58. VITAL SIGNS(TEriP/FULSE/RESP/BLOOD PRESS): 099.0 / 62 / 16 1 130 68
59. HBB: 60. HCT: 61. ABG- I I DATE TAKEN-
62. WBC. 63. SIIVSI: 64. MEDICATIONS. NIAPROSYN 250 MG PO 0 6 HRS, IRON I
TAB 2X DAY PO
65@ HISTORY: 31 YR G2PI FEMALE WITH LONG HX OF PAINFUL PERIOD, NOW HAVING NEW
ORRHAGIA ANEMIA. UT HAS GROWN FROM 8 WK SIZE/JUL 89 TO 12-14 WEEK SIZE AT PR
C@SENT.
66. ATT PHYS: MULLINS 67, PH#: 000 000 0000 68. @IARD#/PH#: 000 / 000 000 0000
69, REPORTED BY: MARCHANT 70. PH#: 000 0000
74. ATTENDANT NAME #I, 75. STATUS: 76. BRADE:
77. AGE: 78. SEX: 76A. WT: 79. RELATIONSHIP TO PATIENT-
80. BAG TYPE- 91. BAG TAG 82. BAG WT:
SS. ATTENDANT NAME #2: 64. STATUS: 85. GRADE:
86. AGE-. 87. SEX: 87A. WT: 66. RELATIONSHIP TO PATIENT:
TAG 91. BAG WT:
92. TRANS BRIG PHONE EXT:
93. TRANS DEST PHONE EXT:
94. ETA DRIG ilTF(DATE/TIME): 000 95. ETA DEST KTF(DATE/TIME): 000
97. OTHER COMMENTS.
51. MSN #: 00001292 52. RON LOC-
57. VALIDATED BY/REAS FOR HIGHER PRECEDENCE:
QA AIRR.RAFT TTTMFRARY: 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