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File: 102896_aug96_decls2_0040.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
05.13 PATIENT FILE 10/22/90
PERSONAL DATA - PRIVACY ACT OF 1974
5 U.S.C. 552 (b)(6) 13. MODE: A
1. NAt'iE-. 18. AUTHORITY 0292AOB3 2. SSAN-. 3. PRECEDENCE: R
4. STAT: All 5. GRADE; E06 6. AGE: 27Y 7. SEX: M B. WT: 14B 9. READY DATE- 292
10. ISO- 11, POR: 12. SPEC CAT.
14. REAS REGI DS 15. DATE LAST VISIT: 16. CLASS, 3A
17. ACCEPT PHYS: 19. AFPT/SURB DATE. NO
20. APFROV AUTH: 21. CANC/IN'U: 22. VALID: SMF Y3
23. MTF DRIG- ASISO USA DISPENSARY DHAHRAN 24. ICAD CRIB: DEDR
25. MTF DEST. F5070 USAFRMC WIESBADEN SE 26. ICAD DEST: EDAF
27. NED SPEC I- SOD 28. DIAS I- 9534 INJURY TO BRACHIAL PLEXUS
29. MED SPEC 2: 30. DIAG 2:
31. MED SPEC 3-. 32@ DIAG 3-
32A. PROCEDURE:
33. SPEC DIET-. N/ 34. IV:
35. 02/LPM: N 1 36. SUCT-. N 37. NG TUBE: N 38. RESP, N 39. FOLEYZ N 40. STRYKER: N
41. INCUB. N 42. TRACT- N 43. IMED. il 44@ CAST/LGC., N 45. TRACH: N 46. KON: N
72. PT BAG TAG 73. PT BAG WT:
47. SUPP INFO: BRAVO COMPANY 3/817 FT CAMPBELL KY ****DESERT SHIELD****** REPORTED BY-
SUB JMRO
48. MAX ENRTE STOPS: Y / 9 49. VAX # RONS: Y @ 9 50. ALT REST/MAX HT: N
53. INPATIENT: Y 54. SPEC PRM- VA DRUG ALCOHOL WT NONE X 55. VA CODE:
56. ADMIN/DVERSEAS.
58. VITAL SIGNS(TEMP/PULSE/RESP/BLOOD PRESS): 098.4 80 / 16 / 110 78
59. HGB: 60. HCT. 61. ABB- / DATE TAKEN:
62. WBC: 63. SI/VSI: 64. MEDICATIONS: TYLENOL 3 PRN, MOTRIN 600MG DID PRN
65. HISTORY: HEILD ACCIDENT TIMES TWO WEEKS, NEEDS MYIFGRAM AND CT SCAN.
66. ATT PHYS: COLBASSINI 67. PH#; 000 000 0000 68. @IARD#IFH#: 000 / 000 000 0000
69, REPORTED BY: HERREMANS 70. PR#: 000 0000
74. ATTENDANT NAME #I: 75. STATUS. 76, GRADE-
77. AGE- 78. SE@ 78A. WT, 79. RELATIONSHIP TO PATIENT,.
80. BAG TYPE: Si. BAG TAG 82. BAG WT:
83. ATTENDANT NAME #2. 84. STATUS- 85. GRADE:
66. AGE: 87. SEX-. 87A. WT: 88. RELATIONSHIP TO PATIENTI
09. BAG TYPE- 90. BAG TAB 91. BAG WT.-
92. TRANS DRIG PHONE EXT:
93. TRANS DEST PHONE EXT:
0 95. ETA DEST MTF(DATE/TIME): 000
97. OTHER CD?,MENITS-
51,. MSN #: 00001292 52. RON LOC:
57. VALIDATED BY/REAS FOR HIGHER PRECEDENCE: 1
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