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File: 102896_aug96_decls4_0013.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
@@l. ih J000/301 52. RON l@O'u:
57. VA,"'DATED BY/@-,EAS FOR PRECED--.\CEz
96. AIRCRA;T IT',N!@ A,@@y:
04:01:27, PATIENT FILE 10/6-0/90
PERSONAL DATA - PRIVACY ACT OF '974
5 U.S.C. 552 (b)(6) 13. MNDE: A
1. NA@'@E: 18. AUTF.ORITY #t 03OIA036 2. SSAi%': 6-. 'RE@'EDc@NIP@Et R
4@ STAT: Al' 5@ GRADE; E07 6. @46c: 28Y 7. SEX: M 0. WT- IQO 9. READY DATE@ 301
io. ISO: 11, PC-R@ 12. SPEC @IAT@
c
14, D@A'o Rc,@,.- DS ir. DATE LAST VISIT: i6. CLASS-. 3A
17. ACCEPT PHYS; 19. APPT/SLIRB DATET NO
2(i rrPROV AIJ]H@ 21. CANC/T,@\!': 2@. VALID' I I JRL I Y2
'-3 ,-AO ORTG@. OEDR
MTF ORIC: A5150 USA DISPENSARY DLI.ALIDAN 24.T
, '@ FDEST: ).5030 FRAN;"FliRT ARMY REG i'!ED 26, ICAG DESTZ EDAF
27, i@iED SPP@@@ 'it SSCV 2R@@ DIAS It 4549 VA.RICOSP VEINS, LOWER EXTREI't!TIES, ULCER/INFLA.MVi NOT V@LENTND
49. @lP@D SPEC 2: 30. DIPG 2-
3@,. M@,D SPEC 3: 3@-. DIAS 'I;
'K2A. DP,00 " REi
33. -Qp--rl DIET: N/ 34. !V@
Z@ 02/LPv: N@ 36. SUP@T: N 37. NG TUBE: %I 38. R@,SP-. N' 719, FOLEY: i\l 40. STRYKER@ N-
41@ IINICUB: ti 42. TRACT; N 43. !MED-. N 44. CVoT/LOC: N 45. TRA'UH: N 46@ MON: N
71@ PT BAD TYPE. RD' 72. PT BAB T ' @: 73. PT BAG WT@
Au
47@ SUPP NFQ: FT HCOD TX 28 CSP@
46@ MAX E@,RTE STOPS-. Y / 9 49. MAX # RONS: Y / 9 50. AIT RCSTI@MAX RT: N@
5@-. INPATIENT Y 34. SPEC PROG: VA DRUG ALCO@@'OL WT NON',-t X 5@@. VA CODET
56. ADM-li%'/OVE@SEAS:
58. VITAL SIGI\tS(TEiMP/@rU'LSEIRESP/BLOOD PRr,SS); 098.0 60 / 16 / 128 96
59z HGB: 60@ PDT: 61. ADS: I DATE TA@,E.N:
62. WBC; 63. SIIVSlt 64. MEDICATIONS! NONE
6:-). '@,ISTGRY: SEVERE VARICOSE VEINS IN L i-EG. LEro' SWELLING PREVENTS WEARING
COMBAT B@ TS. PT NEEDS VEIN ST IPPINra@
U0 R
66, ATT PHYS@ Sl,'aP'@ 67@ P'I#: 000 000 @100@, 68. 000 000 000 0000
69. REPORTED BY: PSGT @IAR@IN 70. P@'@ 000 0000
c
z,. ATTENDANT NAME 75. SIATUS: 76. GRADEZ
77. AG 78. SEX: 78A. WTt 79@ RELAT!Cfi\'@'.IP TO PATIENT
80. BAB TYcF2 81. BAG TAG 82, BAG WT@
Po. 4@i TENDP.NT 2@ 84. ST USt 85. GRADEZ
'AT
86. ASP--. 87. SEX: 87A. @IT' 88. RELATIONS41P TO PATIENT:
O@9. BAB TYPE: 90z BAB TAG 91. BAG @ll:
9@4. TRANS CRIB PP.ONE EXT:
93, TRANS DP-ST NONE EXT-.
A c
?4. CRIB tMTF@n.AT7/TTME): 000 95. E: A DP T @.TF(DAI@/I'-ME): 000
ST @S.
97. OTH@ll
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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