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File: 102896_aug96_decls2_0038.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 '@974
5 U.S.C. 552 (b)(6) 13. MDE: A
1. NAME: 18. AUTHORITY 0292AO26 2. SSAN; 3. PRECEDENCE: R
4. STAT. All 5. GRADE: E06 6. AGE-. 29Y 7. SEX: M S. WT: 185 9. READY DATE: 291
10. 180: 11. OOR: 12. SPEC CAT:
14. REAS REG: DS 15. DATE LAST VISIT: 16. CLASS-. IC
17, ACCEPT PHYS- 19. APPT/SURG DATE: NO
20. APPROV AUTH- 21, CANC/INC: 22. VALID: RAG Y7
23. MTF BRIG: A5150 USA DISPENSARY DHAHRAN 24. ICAD BRIG: DEDR
25. MTF DEST- A5030 FRANKFURT ARMY REG NED 26. ICAD DEST, EDAF
27. NED SPEC 1: MPPS 26. DIAG 1: 30021 ABORAPHOBIA WITH PANIC ATTACKS
29. NED SPEC 2: 30. DIAG 2:
31. NED SPEC 3: 32. DIAG 3-
32A. PROCEDURE-
33. SPEC DIET: N/ 34. IV: 1
35. 02/LPM: N 36. SUCT- N 37. NG TUBE- N' 38. RESP: N 39. FOLEY: N 40. STRYKER- N
41. INCUB: N 42. TRACT: N 43. IMED-. N 44. CAST/LDC: N 45. TRACH: N 46. MON; N
73. PT BAB WT:
47. SUPP INFO: 3/32 ARMOR FORT HOOD TX REPROTED BY-.
USNHE MERCY
48. MAX ENRTE STOPS: Y / 9 49, MAX # RONS: Y/ 9 50. ALT REST/MAX HT: N
53. INPATIENT: Y 54. SPEC PROS: VA DRUG ALCOHOL WT NONE X 55. VA CODE:
56. ADIIN/OVERSEAS:
58. VITAL SIGNS(iEMP/PULSE/RESP/BLDGD PRESS), 098.0 1 60 / 16 / 106 70
59. W)B: 60. HCT: 61. ABG- I DATE TAKEN-
62. NBC: 63. SI/Vgl: 64. MEDICATIONST VALUIM 5MG TID
65. HISTORY: COMPLAINS OF ANXIETY ATTACKS PRIOR TO MED PT PAD ATTACH PER WITE VA
RIED MANIFESTATION LIGHT HEADNESS AND OCCASIONAL BLA@LKGIJT.
66. ATT PHYS. lk'AER 67. PH#: 000 000 0000 68. WARD#/PH#. 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. RELATIONSHIP TO PATIENT:
60. BAB TYPE: 81. BAB TAG 82. BAG WT-
83. ATTENDANT NAME #2-. 84. STATUS: 85. GRADE:
86. AGE- 87. SEX: 87A. WT- 88. RR ATIONSHIP TO PATIENT:
89. BAG TYPE: 90. BAB TAG 91. BAB WT:
92. TRANS GRIS PHONE EXT:
93. TRANS DEST PHONE EXT:
- 000 95. ETA DEST MTF(DATE/TIME). 000
97. OTHER COMMENTS:
51. MSN #. 00001291 52. RON LOC:
j@. VALIDATED BY/IrrAS 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