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File: 102896_aug96_decls4_0014.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. t@-SNI. 4- 0000' O' j2. RON @"-C!C:
57. VAD41ME02BY/REAIs FC@R H T GHER PRP EDENCE: Fl!-
96. AIRCRAFT IT !N'@-RARY: /PEPSC@\IAL DATA/- PRIVACY Ar--i/Gr' 1974 f
5 U.S.C. 552 (b)(6) 13@ @'@,O@IE-. A
1. NAM--@ 'G. A'jTHOR71Y 4,i O3OiAO24 2, SSA@q': 3. PRECEDENCE: R
4. STAT@ All 5. GRADE: E07 6. AGE: 40Y 7@ SEX: M 9@ WT@ 220 9. READY DATE: 301
10, ISO; II. POR@ i 12. SPEC CA-t:
14. @REAS RE@ri DS 15. DA,z LAST VISIT: 6. CLASS: 7A
17. ACCEPT PHY@. ',MRO 19. APPT/SIJRG DATET NO
40. APPROV AUTH: 21. @@ANC/7 C: 22. VAL!DI iRL Y9
2@. MT, ro'RIG: P.51a@ USA DISPENSARY @@ua RAN @,4. ICAC- DRIC: CEDR
2Q'@ IMTF DEST: A5040 2,NTa CEN HOSP LANDSTUHL @z6. !CAD DEST: EDAR
27. ?iED SPEC 1: MMP, 29. DIA@O l@ 78650 UNSPECIFIED CHEST PA TN
29. NED SPEC 2@ 30. DIAS '11;
31. Vi@@D SPEC 3: 'i2@ DIAG 3:
ROCCMURE-.
33, Er-EC D'ET- Y/UNK 34@ TVi
3@.. 02/'@p@l@ N 36. SUCT' N 37. MD TUBE: N 30. R'CSP: N 39. FOLEY; N' 40. STRYKER: N
41. !NCUB: N 42. TRACT: N' 43. TriED- N 44. CAS't/L'u@@i N' 45, TRACP@@ N 46. riON: N
71. PT BAG TYPE: NIB 72@ PT BAG TAG 7S. PT BAG @ITI
47. SUP@O INFO: Ff SIL!-, REPORTED BY
uK
SU AREA@ PATIENT IS FRO,s THE 'DSNS INERCY
48. MAX ENDTzl: STOPS: Y / 9 49. MAX 4' RONS: Y 9 50. Al@T REST/,,".-AX qT@@ i%
51 N 54, SPEC PROG: VA DRUG ALCOHOL @'T NONE X Fu. VA CODE:
@6. ADMIN/DVERSEAS:
5@ 9!TA'@616s\'S(TEPtP/PULSE/@RESP/BLOODPRESS): 099.01 !CiOl 16 110 90
DATE TA,REN@
P@BBZ 60, P@CT- 61, ABB:
&-Z. NBC: 63. SI/VSIi 64. MEDICATIONS: MOT IN 600 TID
.R
65. HISTORY: HISCRY OF BACK PAT'N' AND CREST R@AIN HAS jl@TTE'i PROBRESSIVELY
@4ORSc@ WITH PROLONGED S-lAi\;DING.
000
O v
69@ @EPORTED RYv P07iTER 70@ PH4: 000 0000
74, ATTENDAN, NAME 1: 75. STATUS@. 76, GRADE:
77, AGE: 76. SEX: 76A. WT: 79, RELATIONSHIP TO PAT TENIT@
80@ BAG TYPP-@ 61. BAG TAG #i 82@ BAG ITT;
P.TTrIINDAr\', NAME '@2: 84. STATUS@. 85. GRADE,.
96, AGE: 87. SEX: 87A. @IT: 89. RELATIONSHIP TO PATT ENT:
89. BAG lyPE: 90. BAS TAG 4@. 91, BAG WT:
92@ IRANS CRIS PHONE EXTZ
93. TRANS DEST c,XT;
94. ETA n'RIG MTF(DATE/TIME). 000 95. ETA DEST im@TF(DATE/TTjN'@,E): 000 1
97. 01 HER COMMENTS:
51. MEN #: 6012/301 52. RON LOC.
5'7@ VALIDATED B@'!Rr@IPS FOR HIGHER PRECEDENCE:
96. AIRCRAFT ITINERARY: I
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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