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File: 102896_aug96_decls2_0041.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
Oi.- 13 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 0292AO84 2. SAN- 3. PRECEDENCET R
4. STAT- All 5. GRADE: E04 6. AGE. 25Y 7. SEX: M 8. WT: 215 9. READY DATET 292
10. ISO@ 11. POR- 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. CANIC/INC: 22. VALID: SMF Y7
23. MTF CRIS: A5150 USA DISPENSARY DHAHRAN 24. ICAG BRIG: DEDR
25. MTF DEST: F5070 USAFRMC WIESBADEN GE 26. ICAO DEST: EDAF
27. NED SPEC I-. SOD 28. DIAS 1. 7177 CHONDROMALACIA OF PATELLA
29. NED SPEC 2. 30. DIAG 2:
31. NED SPEC 3: 32, DIAS 3:
32A. PROCEDURE:
. SPEC DIET, NI 34. IV:
35. 02/LPM- N 36. SUCT: N 37. NS TUBE: N 38. RESP: N 39. FOLEY: N 40. STRYRER: N
41. INCUB: N 42. TRACT: N 43. IMED, N 44. CAST/LOC. N 45. TRACH. N 46. MON: N
72. PT BAB TAG 73. PT BAB WT:
47. SUPP INFO: 2424 IORN 6 DIVISION, FT STEWART GA REPROTED BY:
SUB JKRD *******DS*******
48. MAX ENRTE STOPS: Y / 9 49. MAX # RONS: Y / 9 50. ALT REST/MAX HT: N
53. INPATIENT: Y 54. SPEC PROB: VA DRUG ALCOHOL WT NONE X 55. VA CODE:
56. ADiMIN/GVERSEAS:
59. VITAL SIGNS(TEMP/PULSE/RESPIDLOOD PREt-)S). 098.5 68 16 / 118 70
59. HBB: 60. HCT: 61. AN: DATE TAKEN:
62. WBC: 63. SIIVSI: 64. MEDICATIONSI NONE
65. HISTORY: RT MULTIFIF KNEE DIFUSSION, TWO PRIOR SURGERIES, VERY WEAK, ADMITTE
D 17 OCT 90.
66. ATT PHYS-. JONES 67. DH#@ 000 000 0000 69. WARD#/PH#: 000 / 000 000 0000
69@ REPORTED BY: HERREMANS 70. PH#: 000 0000
74. ATTENDANT NAME #I- 75. STATUS: 76. GRADE-
77. AGE: 79. SEX.- 7BA. WT: 79. @TIONSHIP TO PATIENT:
60. BAG TYPE. 81. BAG TAB 82. BAG WT-.
83, ATTENDANT MAKE #2: 84. STATUS: 85. GRADE:
86. AGE- 87. SEX- 87A. WT: 88, RELATIONSHIP TO PATIENT:
89. BAB TYPE: 90. BAG TAG 91. BAB WT:
92. TRANS DRIG PHONE EXT,
EXT:
94. ETA GRIG MTF(DATE/TIME): 000 95. ETA DEST MTF(DATE/TIME): 000
97. OTHER COMMENTS-
51. MSN #- 0000/292 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