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File: 102896_aug96_decls2_0036.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 FILE 10122/90
PERSONAL DATA - PRIVACY ACT OF 1974
5 U.S.C. 552 (b)(6)
13. MODE: A
1. NAME-, 18. AUTHORITY 029IAOOI 2. SSAIN: 3. PRECEDENCE: R
4. STAT- All 5. GRADE: E04 6. AVE. 21Y 7. SEX: M B. WT. 180 9. READY DATE: 291
10, 150: 11. PORT 12. SPEC CAT:
14. REAS REG., DS 15. DATE LAST VISIT- 16. CLASS. 2B
17. ACCEPT PF@YS: 19. APFi/SURG DATE: NO
20. APPROV AUTH: 21. CANC/INC: 22. VALID-. SMF Y6
23, MTF BRIG. A5150 USA DISPENSARY DHAHRAN 24. ICAG ORIS: GEDR
25. MTF DEST: F5070 USAFRMC WIESBADEN GE 26. ICAD DEST: EDAF
27. NED SPEC 1: SOD 28. DIAG 1: 7242 LUMBAGO
29. VIED SPEC 2: 30, DIAG 2:
31. MzD SPEC 3-. 32. DIAG 3-
32A. PROP,EDURE.
33. SPEC DIET., N/ 34. IV:
35. 02/LPM: N 36. SUCT: N 37. NS TUBE: N 38. RESP. N 39. FOLEY: N 40. STRYKER: N'
4. CAST/LGC: N 45. TRACH: N 46. MON: N
71, PT BAB TYPE: NB 72. PT BAG TAG 73. PT DM WT:
47. SUPP INFO: DESERT SHIELD DS:
48. MAX ENRTE STOPS, Y / 9 49. MAX # RONS- Y / 9 50. ALT REST/MAX KT: N
53. INPATIENT: Y 54. SPEC PRDG- VA DRUG ALCOHOL WT NONE X 55. VA CODE:
56. ADMIN/GVERSEAS-.
58@ VITAL SIGNS(TEMP/PULSE/RESP/BLOOD PRESS): 098.8 70 / 18 / 100 72
59. H$B. 60@ HCT, 61. ADD: I DATE TAKEN:
62. WBC: 63, SI/VSI, 64. MEDICATIONS: VALIUM 10MG TID, MOTRIN BOOMG TID
65. HISTORY: PT HAS PERSISTENT LBP, NO RESPONDING TO TREATMENT, NEEDS EVAL ADR.
66. ATT PHYS: COLE 67. PH#c 000 000 0000 68. WARD#/PH#g 000 / 000 000 0000
69. REPORTED BY-. A5150DENTGr4/GK 70. PH#. 000 0000
74. ATTENDANT NAME #I: 75. STATUS: 76. GRADE:
77. AGE- 78. SEX: 78A. WT- 79. RELATIONSHIP TO PATIENT:
80. BAG TYPE: 81. BAG TAG 82. BAG WT:
83, ATTENDANT NAME #2: 84. STATUS. 85. BRADE:
86. AGE: 87. SEX: 87A. WT: 08. RELATIONSHIP TO PATIENT:
89. BAB TYPE: 90. BAB TAG 91. BAB WT:
92. TRANS BRIG PHONE EXT.
93. TRANS DEST PHONE EXT-
94, ETA BRIG KTF(DATE/TItT): 000 95. ETA DEST MTF(DATE/TIME): 000
97. OTHER COMMa4TS.
51. MSN #: 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