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File: 102896_aug96_decls2_0034.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
04:39 PATIENT FILE 10/22/90
PERSONAL DATA - PRIVACY ACT OF 1974
5 U.S.C. 552 (b)(6) 13. MDDEZ A
1. NAME: 18. AUTHORITY #- 029OA044 2. SSAN 3. PRECEDENCE: R
4. STAT: All 5. BRADE. E05 6. AGE: 25Y 7. SEXI M S. WT: 145 9. READY DATE. 290
10. ISO- 11. POR- 1 12. SPEC CAT:
14. REAS REG: DS 15, DATE LAST VISIT: 16. CLASS: 3A
17. ACCEPT PHYS: JMRO 19. APPT/SURB DATE: NO
20. APPROV AUTH: 21. CANC/INC- 22. VALID@ TJH Y6
23. MTF CRIS: A5150 USA DISP04SARY DHAHRAN 24. ICAD CRIS: GEDR
25. NTF DEST: A5040 2ND GEN HOSP LANDSTUHL 26. ICAD DEST@ EDAR
27. MED SPEC 1: SOD 28. DIAG 1: 7292 NEURALGIA, NEURITIS, AND RADICULITIS, UNSPECIFIED
29. NED SPEC 2- MIMN 30. DIAG 2i 3559 MONONEURITIS OF UNSPECIFIED SITE
31. MED SPEC 3: 72. DIAG 3:
32A. PROCEDURE:
33. SPEC DIET: N/ 34. IV,.
35. 02/LPM-. N 36. SUCT: N -)7. NG TUBE: N 38. RESP: N 39. FOLEY: N 40. STRYKER: N
46. MON: N
71. PT BAB TYPE: NB 72. PT BAB TAG 73. PT BAB WT:
47. SUPP INFO: DESERT SHIELD DS: 90 SEZ 4TH TOG FT BRAGG, NC
48. MAX ENRTE STOPS: Y 1 9 49@ MAX # RONS: Y 1 9 50. ALT RESTIMAX HT- N
53. INPATIENT: Y 54. SPEC PROG: VA DRUG ALCOHOL WT NONE X 55. VA CODET
56. AD@',IN/GVERSEAS:
56. VITAL SIGNS(TEMP/PULSE/RESP/BLOOD PRESS): 098.4 68 / 14 / 98 1 68
59. PGB. 60. HCT: 61. ABB: I DATE TAKEN:
62. WBC- 63. SI/VSI: 64. MEDICATIONS: MOTRIN 600MG 6'/MEALS
65. HISTORY- PT W/HX OF PROGRESSIVE WEAMESS OF RI GASTROC NOW HAS DIFFICULTY WA
LKING, NEEDS NEUROLOGY CONSULT AND EMB.
66@ ATT PHYS: BURECIiMl 67. PH#, 000 000 0000 68. WARD#IPH#- 000 / 000 000 0000
69. REPORTED BY: A5150 HERRFANS 70. PH#: 000 0000
74. ATTENDANT NAME #I: 75. STATUS-. 76. GRADE:
77. ABE- 78. SEX: 79A. WT: 79. RELATIONSHIP TO PATIENT:
80. BAB TYPE-. 81. BAB TAG 82. BAB WT:
81. ATTENDANT NAME #2. 84. STATUS- 85. BRADE;
06. AGE: 87. SEX, 87A. WT- 88. RELATIONSHIP TO PATIENT:
89. BAG TYPE- 90. BAG TAG 91. BAG WT.
92. TRANS DRIG PHONE EXT:
EXT:
94. ETA DRIG NTF(DATE/TIME): 000 95. ETA DEST MTF(DATE/TIME): 000
97. OTHER COMMENTS:
51. MSN #: 52. RON LOC:
57. VALIDATED BY/FEAS FOR HIGHER PRECEDENCE:
96. AIRCRAFT ITINERARY. I 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