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File: 102896_aug96_decls2_0037.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
05-15 PATIENT FILE 10/22/90
PERSONAL DATA - PRIVACY ACT OF 1974
5 U.S.C. 552 (b)(6) 13. MODE: A
1. NAME. 18. AUTHORITY 0292AO25 2. SSAN- @ 3. PRECEDENCE: R
4. STAT: All 5. GRADE: E04 6. AGE: 21Y 7. SEX: M 9. WT: 145 9. READY DATE: 291
10. ISO-. 11. DOR- 12. SPEC CAT:
14. REAS REG: DS 15. DATE LAST VISIT- 16. CLASS: 3A
17. ACCEPT P'RIYS: 19. APPTISURG DATE: NO
20. APPROV AUTH: 21. CANC/INC: 22. VALIDT RAG Y7
23. MTF BRIG. A5150 USA DISPENSARY DHAHRAN 24. ICAG BRIG- OEDR
25. MTF DEST. A5010 FRANKFURT ARMY REG NED 26. ICAD DEST: EDAF
27. NED SPEC 1. SOO 28. DIAG 1: 71831 RECURREN, DISLOCATION Gi- JOINT OF SHOULDER REGION
29. NED SPEC 2. 30. DIAG 2.
31. MED SPEC 3: 32. DIAS 3:
32A. PROCEDURE!
33. SPEC DIET- N/ 34. IV:
35. 02/LPM- N 36. SUCT: N 37. NG TUBE: N 36. RESP-. N 39. FOLEY: N 40. STRYKER: N
INCUB: N 42. TRACT: N 43. IMED- N 44. CASTILOC, N 45. TRACH: N 46. MON: N
71. PT BAG TYPE: NB 72, PT BAG TAG 73, PT BAG WT:
47. SUPP INFG- HHC 18TH AV BRr@ FORT BRAGG NC REPORT BY: U
SNHS MERCY
48. MAX ENRTE STOPS, Y 9 49. MAX # RONS, Y / 9 50. ALT REST/MAX HT: N t
53. INPATIENT: Y 54, SPEC PRGG: VA DRUG ALCOHOL WT NONE X 55. VA CODE.
56. ADMIN/DVERSEAS:
59. VITAL SIGNS(TEMP/PULSE/RESP/BLGOD PRESS): 099.0 1 60 / 16 / 114 80
19. HGB: 60. HCT: 61. ARG- I DATE TAKEN:
62. WBC- 63. SI/VSI: 64, MEDICATIONS: NONE
65, HISTORY: 5 PREVIOUS EPISODES OF L SHOULDER DISLOCATION, LAST DISLOCATION 15
OCT 90 WHILE SWIMING.
66. ATT PHYS: CULT 67. PR#: 000 000 0000 68. WARD#/Pfl#: 000 / 000 000 0000
69. REPORTED BY: HERREMANS 70. PH#. 000 0000
74. ATTENDANT NAME #I: 75. STATUS- 76. GRADE:
77. AGE- 78. SEX: 78A. WT- 79. RR ATIGINSHIP TO PATIENT-
80. BAG TYPE. 81. BAG TAB 82. BAB WT:
B,-). ATTENDANT NAME #2: 04. STATUS- 85. GRADE:
87A. WT-. 88. RELATIONSHIP TO PATIENT-
89. BAG TYPE-. 90. BAB TAG 91. BAG WT:
92. TRANS BRIG PHONE EXT@
97@. TRANS DEST PHONE EXT.
94. ETA BRIG MTF(DATE/TIME): 000 95. ETA DEST MTr(DATE/TIME): 000
97. OTHER COMMATS-
5',. MSN #. 0000/291 52. RON LOC:
57. VALIDATED BY/REAS FOR HIGHER PRECEDENCE:
96. AIRCRAFT ITINERARY: 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