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File: 102896_aug96_decls4_0012.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 0000/301 52. RON'
57. VALIDATED BY!@.Ag FOR HIGHER PRECEDENCE:
96. AIRCRAFI ITINERARY: I
04:00:58 PATIENT FILE 10/30190
PERSONAL DATA - PRIVACY ACT OF 1974
5 U.S.C. 552 (b)(6)
13.
18, AUTHORITY #: 03OIA033 2. SSP.NL@ 3. PRELEDEN,@,: R
4m S'AT@ All 5. GRADE: E09 6. Proc-: 36Y 7. SEX: M S. WT@ 175 9. READY DATE: 301
10. !sag ll@ POR: 1 12. SPEC @,AT:
14, REAS REB- DS 15. DATE LAST VISIT@ i6@ CLASS. 3A
17. ACCEPT PHysg 19. APPT/SURS DATE: NO
20. APPROV AUTH: 21. CANP@/INC: 22. VALID; JR'@ Y2
23. riTF ORIG- A5!50 USA DISPENSARY DHAHRAN 24. TCAD ORIC: OC,DR
25@ MT" DEST: A5030 FRANKFURT ARMY PEG NED 26. ICAO DEST; EDAF
22 !NTERVF-:RTEBRAI@ DISC DISPLACEMENT WC @l-iYELOPATHY, SITE UI%SPEC
27. MPD SPEC 2: --,O. N.IAG 2:
71 @AC
@4. t@icd S.-EC 3: -52@ DT
'o2A. PRP@,CEDURE@
33@ SPEC DIET: 34@ !V-
3'@. 021',PM.: N I 36. SU@'T; N 37@ @,G IUBE: N' 38. RESP: I,' 39. FOLEY: N 40. STRYKER:
41, !NCUBI N 42. TRACT: N 43. ijMED: N 44, CAST/LC@@: N 45. TRACP,: N 46. MGJN:
71. PT BAB TYPE: NIB 72. PT BA@ TAB 73. PT BAB WT:
47. SUPP TNIFD. FT CAMPBELL KY 26 CS'@
1
46. MAX ENRTE SIOPS: Y / 9 49. VAX t OONS: Y I 7 50. Al@T PEST/MAX PT: kt
53. INPATIENT: Y 54. SPEC PROS: VA DRUG ALCOHOL -PYT NONE X 5'@. VA CODE:
56. AVi7N/OVERSEAS:
AD @
VI-,Al
STGI'@S(TEriP/PULSE/,RESP/E'@OOD PRESS): 096.6 76 / 20 104 60
59. HOB@. 60. HCT; 61. ADD: DATE TA@Ekl-.
62. WB'U: 63. SI/VSI: 64. '4.EDICATIONS! @MOTRIN 800 MD TiD VALIUM i@3 TID F
OR PAIIJ. TYLENOL 3 PO. nlD
65@ HISTORY: PROGRESSIVE 1;4EAKNESS FOUND T F.AV' HERNIA, D NUCLEUS Pl@ILPI@'S HAD CT
BEFORE DEPLOYMENT - AGGRAVATED VJHTLE IN' A-DR,
66. @IARD#/PHYi: 000 000 000 0000
67. REPORTED BY: @MS'UT 70, Pq#: 000 0000
A-
@iTEi%DANT NAME #I. 75. STAIUS: 76. GRADE@
74
77. AGE% 78. SEX: 79A. 79. RELATT
80. BAG TYPE: 81. BAG TAG TO PA'IENTT
82. BAG WT-.
A71-LN'DANT NAME 2@ 84@ STATUS: 65. GRADE:
96. AGE: 87. SEX: 87A. WT: 88. RELATIONSHIP TO PATIENT:
69. BAG TYPE: 90. BAG TAG 91. BAG 14':
9'4@ TRANS n@Riu@ @XT.
93. DEST PHONE
94; ETA DRIS iriF(DATE/TIME); 000 95, ETA DEST mTF(n@A-iE/TIME): 000
?7@ OTHER CD-iMc@kI.Ts:
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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