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File: 102896_aug96_decls4_0015.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
04;08:20 PATIENT FILE 10/710/90
PERSONAL DATA - PRIVACY ACT Or- '.974
5 U.S.C. 552 (b)(6) 13. i@,fiDE@ A
NAME: AUTHORITY @: O@OIA,02Z 2. SSAN: 3. PRECEDENCE: R
4. ST T@ All 5. GRADE- c@04 6@ AGc@ 'L7Y 7. SEX; M S. WT: l@@6 9. READY DATE: 301
@A.
10@ l@@O-@ 11. POR: 12. SPEC CAT:
14. REAS Rc'o@@ DS 15, DATE LAST VISITT 16. CLASS: 2B
17. ACCEPT PHYS: JVt'-Io 19. APPT/SURG DATE: NO
20. A.@OPROI) AUT : 21. 'UAXC/INP: 22. VALID@ ORL Y9
.H
23. @,TF 001-@: A' .150 USA DISPENSARY DHAHRAN 24@ ICAG CRIB: CC,DR
25. @itF DEST: A@,030 FRANKFURT ARMY REG MED 26, I,-.AG DEST: EDAF
27. N-LD SPEC It SOD 28. DLArz It 71906 EFFUSION OF LOWP-R LEG JOINT
29. MF-D SPEC 2@ 30. DAB 2:
r@ED SPEC 3: 31,. DIAG 3-.
32A. PROCEDI,@PE@
33. SPEC Di@cT: Ni' 34. iv!
c
02/LPiN@ N 36. SU',T: N 37. TUBE; tl 36, R@'SP: ii 39. FC'@,Y@@ N' 40. STRYKER: N,
4' .', t@"@UB: N 42. TRA'@TI N 43, liMED- N 44, CAST/LOCi @N' 45. TRACH: @N' 46. MN: N
71. -T @A.-C TYPI-:: \12 72. @'; BAB TAB 73. PT BAPO 6'T;
47. SUr@p TN.@-0: SIND ABN FORT BRA G,,NC REPORTED BY
..s
B l@l,4 AREA - PATIENT IS OFF THE LIS@%16 MER@RY
48@ MPX EN@RTE STOP'--@ Y / 9 49. l,@AX # RONS: Y 9 @@0. Ai-T R-,ST/MAX @'Ta N i
5--,. INPATIENT: t@' 54. SPEC PROB! VA DRUG ALCOHOL WT NONE X 55, VA CODE:
56. AD@'ilN/GVc@RSEAS,
56@ VITAL SIGNS(TEMPIPULSEIRESP/BLn.GD Rc@66):
59, 1,@'CD; 6'0. Hz'-. 61. ABBI I T ' KEN:
.Ai@- iA
62, 14BC@ 63. SI/VSlt 64. YiED'kCA TTO;@6; TYLENOL 3 325 MG PR\'
65. HISTORY@ KNZE IIQUPY DAYS AGO. POSSIBLE SURGICAL INTEO ENTION' REOLIRED,
'IV
LEG IS SFLINT
66. @ITT @@.YS; E@,ALI'MAN, @,7@ PH : 000 000 0000 68. @IARD4/PH#: 000 @00 000 (1000
69. R--POR"ED BY: PO,TE D 70. 'q#: 000 0000
74. ATIE@4DANT NAME #It 75. STATUS: 76. GRADF@
78, SEX: 784. @IT: 79. RELATIONSHIP TO PATIEN T-
SCI. BAG TYPcli Bi. BAG TAG #g 92. BAG 'wT:
97,@ VI TEiNDA@\'T NIP,@E @,2: 84. STATUS: 85. SRPDE;
66. PCET 87. SEX: 87A. WT: 98. RELATIONSHIP TO PATIENT;
89. GAS TYPE; 'O. BAD TAB 91. TIAG WT:
92, TTZANS O@RIC PHONE EXT:
9@@ TR NS DEBT PHONE 4: EXT;
91@@ ETA DRIG MTF(D.ATE/TIME)-. 000 95. ETA DESI V,@r(DATE/TIM@); 000
97, OTHED CO@F.ENITS@.
@@l. !.ISIN 4, 6'yl@21301 52. RON LOC:
57. VALIDATED BY/REAS FOR HIGHER PR7@@uEDENCEt
96. AT.RCRAF@ ITINERARY; I f
I 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