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File: 102896_aug96_decls4_0011.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: 11
51. @,SN #: 00 0/302 RON LOG:
57. VALIDATED PY/R-@@AS FOD
96@ AIRCRAFT TTNERARY@
04@00-.39 PATiEN'7i FILE 10/30/90
PERSONAL DATA - PRIVACY ACT OF i974
5 U.S.C. 552 (b)(6)
13. i@iDDE: A
1. i\'A,@i'c: L 16. AUTHORITY #: 0301AO29 2. SBAN: 3. PRECEDENCE: R
4. StATi All 5@ GRADE: E03 6. AGE; 19Y 7. SEXI M, 8. WT: 49 9. READY DATE: 301
10. !Su: !I. POR: 12. SPEC CAT:
14. REAS REG; DS '-5@ DATE LAST VISIT: 16. CLASS: 3A
17@ ACCEPT PHYS: 19, APPT/SURG DATE: NO
20. APPROV AUTH: CPNC/INC: 22. VALID: JRL Y9
23. I'jT-- DRIG: A5150 USA DISPENSARY DHA@HR,4,N 24. !CAG ORIG: GEDR
25. TITF DEST: A5030 FRANKFURT ARMY REG ,It 26. ICAD Dr-.ST: EDAF
27. NED SPEC 1: @MMC 28. DIAS I- 7602 SYNCOPE AND COLLAPSE
29. MED SPEC 2; 30@ DIAS 2:
31. jmED SPEC 3: 32@ DIAG 3;
EDLIR'@t
--- - DIET;
,7. SPEU YIUNK 34. IV:
5@ 02/LPvj: N1 36. SLICI-@ N' @,7. NG TUBE: N 38. RESP: N 39@ FOLEY: N 40. STRYKER@ N
4'L. IN'CUB; N 42. TRACT:N 43. !MED: )@ 4@4. CAST/LOCz N 45. T@RA@lh',, N 46@ ".DN: N
71. Pi BAB TYPP-T MB 72. PT BAG TA@ ;t 7@. P- BAG @IT:
47@ SLIPP A CO 224 SUPPORT EN FT ST @JART, GA REPORTED BY
2Q@ @-6
4E. 14AX ENRTE 37]OPO@@ Y9 49. i@(AX '@ RONS: Y 9 '@o@ ALT RES'/M@AX HT: N
--IN@DAT ki, %
11 7: @ 1
4. SPEC PRO---t VA DRUG ALCOHOL WT NONE X 5@'. VA CODE:
@,6@ AD?i'L@,%I.IGVFRSEAS:
59, VITAL Q-IrzNS(TEMPIPULSE/PESP/DLODD PRESS): 098.9 1 62 18 10,2 88
59. HGB: 60. HCT: 61. ABST DATE TAVENI:
@2. NBC: 63. SI/VGI: 64. MEDICATIONS; Nln c
@N@
63. HISTORY- TFREC FAINTING EPISODES 1417 OUT WAO INS IN APRIL 90 AND THREE MORE
FOUR DAYS ACO, FOLLO!I)ED BY MENTAL -@ON@FUSIONi. PATIENT HAS RIGHT FRONTAL HEADA
C',4.c@s AND BIT Tn@Nc@P@ Di\!CE.
66. P.TT PHYS: HAAS-.WESTON 67. P@4#@ 000 000 0000 68. WARD#/PH.#: 000 / 000 000 0000
69. REPORTED BYi EDERLEY 70@ PH@.; 000 0000
ME #1@ 7@@. STATUS. 76. GRADE!
77. AGE' 78. SEX: 78A. @IT: 79. RELATIONSHIP TO PATIENT:
80@ BAG TYPE: 81. BAG iAG 6'4. BAB 14T@
871. ATTENDANT NAME #2: 84, STATIJS,. 85. GRADE:
86. AGE: R7. SEX: 97A,. Vl,-@ 88. RELATIONSHIP T PATTENTG
.0
89@ @;,qfz TYPE: 90. BAG TA@c 91. BAG WT:
92. IRANS ORI@L rP.ONF f: -Cxl:
9--',. TRANS Dr T n ONE t@ EXT:
Is, I @l
?4@ E--A OR',g MTF(DATF-:/T'ME@: @40 1 95@ ETA DEST I@TF(DAT /TI@l,'): 000 I
iE
97. OT
.H-R
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Document 31 f:/Week-32/BX000482/MEDSTAT - SITREPS OCT 90 3 OF 4/patient file:10019616503620
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 # = 11
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