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File: 102896_aug96_decls2_0035.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
05-07 PATIENT FM 10122/90
PERSONAL DATA - PRIVACY ACT OF 1974
5 U.S.C. 552 (b)(6) 13. MODE: A
1. NAME: 18, AUTHORITY 0292AO86 2. SSAN:M 3. PRECEDENCE: R
4. STAT: All 5. GRADE. E07 6. AGE: 3BY 7. SEX,. M B. WT: 179 9. READY DATE: 292
10. ISO- 11. POR- 12, SPEC CAT:
14. REAS RES: DS 15. DATE LAST VISIT: 16. CLASS: 3A
17. ACCEPT PHYS-. 19. APPT/SURS DATE: NO
20. APPROV AUTH: 21. CANC/INC: 22. VALID: I SMF Y7
23. MTF ORIS: A5150 USA DISPENSARY DHAHRAN 24, ICAD BRIG: BEDR
25. MTF DEST. A5030 FRANKFURT ARMY REG NED 26. ICAD DEST: EDAF
27. NED SPEC I-. SOD 28. DIAS 1: 61318 FRACTURE OF RADIUS WITH ULNA, UPPER END (ANY PART), OPEN
29. NED SPEC 2: 30. DIAS 2:
31. ?iED SPEC 3: 32. DIAG 3:
32A. PROCEDURE:
33. SPEC DIET.@ NI 34. IV:
3i. 02/LPP,: N 1 36. SIJCT. N 37. NG TUBE: N 38. RESP: N 39. FOLEY: N 40. STRYKER: N
41, IN'LUB: N 42. TRACT; N 43. IMED.- N 44. CAST/LOC- Y / RA 45. TRACH: N 46. MON: N
72. PT BAG TAG 73. PT BAB WT:
47. SUPP IRFO@ C COMPANY 51/1 IOIST AVV FT BRAGG NC REPORTED BY-
SUB OMRO *****DS***** STATES IN HISTORY DO NOT BI VALUE CAST
48. MAX ENRTE STOPS: Y / 9 49. MAX # RONS-. Y / 9 50. ALT REST/MAX HT: N
53. INPATIENT- Y 54. SPEC PROG: VA DRUG ALCOHOL WT NM X 55. VA CODE:
56. ADMIN/GVERSEAS,.
58. VITAL SIGNS(TEMP/PULSE/RESP/BLOOD PRESS): 098.3 88 / 16 / 138 / 90
59. HGB-. 60. W-T,. 61. ABG. / DATE TAKEN:
62. WDC: 6,4. SI/Vsl: 64. MEDICATIONS- TYLENOL WI CODINE PO
65. HISTORY. PT PLAYING FOOTBALL FELL ON RT WRIST RESULTING IN FX. PT HAS CAST
AND METAL OUT RIGER. BURG TWO DAYS AGO, CAST TWO DAYS OLD.
DO NOT BI VALVE.
66. AFT PHYS: CULT 67. PH#: 000 000 0000 68. WARD#/PH#: 000 / 000 000 0000
69. REPORTED BY: HERREMANS 70. PH#@ 000 0000
74. ATIENDANT NAME #I. 75. STATUS: 76. GRADE:
77. AGE: 78. SEX: 78A. WT- 79. @TIONSHIP TO PATIENT:
80. BAG TYPE., 81. BAB TAG 82. BAG WT-
83. ATTENDANT NAME #2: 84. STATUS: 85. GRADE:
86. ABE: 87. SEX- 87A. WT: 89. RELATIONSHIP TO PATIENT:
89. BAB TYPE. 90. BAG TAG 91. BAB WT:
RANS BRIG PHONE @ft: EXT:
93. TRANS DEST PHONE #: EXT-.
94, ETA BRIG MTF(DATE/TIME): 000 95. ETA DEST MTF(DATE/TIME): 000
97. OTHER COMME14TS:
51. MSN #-. 0000/292 5'-). RON LOC:
57. VALIDATED BYIREAS FOR HIGHER PRECEDENCE:
96. AIRCRAFT ITINERARY- I 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