Document Page: First | Prev | Next | All | Image | This Release | Search
File: 102896_aug96_decls2_0039.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 FIIF 10/22/90
PERSONAL DATA - PRIVACY ACT OF 1974
5 U.S.C. 552 (b)(6) 13. MODE: A
1. NAME: 18. AUTHORITY 0292AO27 2. SSAN: @ 3. PRECEDENCE: R
4. STAT- All 5. GRADE: 001 6. ABE: 29Y 7. SEX: tl 8. WT-. 170 9. READY DATE: 291
10. ISO: I 1. PGR: 12, SPEC CAT:
14. REAS REG: DS 15. DATE LAST VISIT: 16. CLASS: 3A
17, ACCEPT PHYS: 19. APPT/SURB DATE: NO
20. APPROV AUTH: 21. CANC/INC. 22. VALID: RAG Y7
23. MT DRIG: A5150 USA DISPENSARY DHAHRAN 24. ICAD ORIG: GEDR
25. VTTF DEST-, A5030 FRANKFURT ARMY RES MED 26, ICAO DEST: EDAF
27. MED SPEC I-. SOD 28. DIAG I- 79910 INTERVERTEBRAL DISC DISPLACEMENT WO MYELOPATRY, LUMBAR
29. MED 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
4. CAST/LGC: N 1 45. TRACH: N 46. MON: N
71. PT BAG TYPE. NB 72. PT BAG TAG 73. PT BAG WT-
47. SUPP INFO: 82ND ABN FORT BRAGS NC REPORTED BY:
USNHS MERCY
46. MAX ENRTE STOPS- Y 9 49. MAX # RONS: Y / 9 50. ALT REST/MAX NT: N
5@. INPATIENT@. Y 54, SPEC PRUG- VA DRUG ALCOHOL WT NONE X 55. VA CODE:
56. ADMIN/GVERSEAS:
58. VITAL SIONS(TEMP/PULSEIRESP/BLOOD PRESS): 098.2 6F4 / 16 / 116 70
59. HGBI 60. MCI. 61. ABG- / DATE TAKEN-.
62. WEC: 63. SI/VSI: 64. MEDICATIONS: TYLONIAL 3 MOTRIN 800 MD TIB
65. HISTORY. COMPLAINED OF LOW BACK PAIN ON 14 OCT FROM JUST BENDING OVER - NO
PRIOR HISTORY.
66. ATT PHYS-@ CORDASFINI 67. PH#-. 000 000 0000 68. WARD#/PH#: 000 I 000 000 0000
69. REPDRTED BY- HERREMANIS 70. PR#: 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:
B3. ATTENDANT NAME #2: 64. STATUS,. 85. GRADE-
86. AGE-. 87. SEX: 87A. WT: 88. RELATIONSHIP TO PATIENT:
91. BAB WT:
92. TRANS GRIG PHONE EXT-
971. TRANS DEST PHONE EXT:
94. ETA OR16 MTF(DATE/TIME), 000 95. ETA DEST MTF(DATE/TIME): 000 1
97. OTHER COMMENTS:
51. MSN #: 0000/291 52. RON LOC:
57. VALIDATED BY/REAS FOR HIGHER PRECEDENCE-
96. AIRCRAFT ITINERARY: I
Document Page: First | Prev | Next | All | Image | This Release | Search
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