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File: 102896_aug96_decls4_0016.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
04:09-.37 PATIENT FILE 1,0/30'90,
PERSONAL DATA - PR TVA@ ACT O' '974
1 uy r 1
5 U.S.C. 552 (b)(6) 13. MODE: A
NAME: 18@ @UT,4,"@RliY @: 03OIA027 2. SSAN: 3. PRECEDENCE: R
4= STATI A"L 5. GRADE; c@03 6. ACEZ 20Y 7. SEX: S. 14T: IBO 9. READY DATE; 301
'O. !So; 11. POR; 12. SPEC CAT:
14@ REAS R@cG@ DS 15. @.AT LAST VISIT: 16@ CLA.SS@. @A
.E
17@ ACCEPT PHYS- JR@RO 19. APPTISURG DATE@@ NO
20@ APPROV A,@'jTH: 21. CANC/ILNIC: 22. VALID: JRL I Y9
2-0@ MTF ORTR-
A5'50 USA DISPENSARY DHAHRAN 24@ ICAD OR16t DEDR
25. MTF DclsTi A5030 FRANKFURT ARMY @REG @lcD 26. ICAD DEST: EDAF
SPEC 1: Fill 28. DIAS l@ 99z'O HEAT STROKE AND SUNSTROKE
29@ Mf:D SPEC 2@ 30. DlAfo 2-.
31@ rj;-7D SPEC 3@ 32. DIAG 3:
,@2A. PROCEDUR@-T
o3@ SPEC Dlc@T: NI 34. IV;
35- 02/LPF,: @N 1 36. SU@IT: @4' @',7. NS TUB@ @N' 38. RESP: N 39. FOLEY: 40. STRYKER: N
4'. TN-LUB: N 42@ TRA@CT@ i@! 4,3. IMED: Ni 44. CAST/LCC: N 4o@ TRACH: N 46. iNOi4i N
71. Pi BAB TYPE-. NB 72, P-1 BAB TAG 73, Pi BAB t4l@
47@ SUPP TINFG,, FORT h'OOD, TX REPORTED BY
SLI@ A
F: PATIENT IS OFF TH@ TAERCY
AREA L
46. MAX ENRIE SIOPS: Y / 9 49. MAX # RONS: Y 9 50. ALT RESTIMAX HT; N I
Tt,10 -4. SPEC PROS: VA DRUG NLCU-H.BL @,T NONE X
@3 @ , @ATIE@,,T: i\l 3 55. VA CODE@
56. ADI",!N/DVERSEP.S:
58. V!iA!- SIGNS(-iE@IP/PULSE/RESP/B"DOD PRESST-. 0'78.0 / 74 16 il2 64
@9. FGB- 60. HOT; 6i. APO: I I DATE T kEN2
,A
64. NDICATIONS: FLAGYL 150 MO TID
6@.. @TSTORY: W-- T 1, -LL L% @,E
RO.",E 17 OCT. OBSERVED HY@@RA'10,\t, SHIGE Sli NE GI,\ THEN
-A,ST
66- A@Ti Di@'YS@. UNK 67. PX#@ 000 C'MO 0000 68. VIA D#IPF,M 000 000 000 0000
,.R
69. REPORTED BY: HsM@@ Bc@,iT!Z 70@ PP,4@: 000 0000
74. ATTC naANT NAME #I: 75. STATUS: 76. GRADET
. @iN
77. AGE: 78. SEX: 78A. felt 79, RELATIONSHIP TO PATIENT:
80, BAB TYPE: BAB T o@ 82. -@AG WT@
.A
65@ CRADE-.
,3. ATTENDANT NAME *2: 84. STATUS:
86. AGE@ 67. SEX: 67A. WT: 89. RELATIONSHIP TO PATIENT:
69. DAG TYPE: 90. BAB TAG 91. DAG Wi@
T:
97-. TRANS DEBT PHONE @: EXT:
90,@ ETA CRIG @ITF(DATE/TIIAE): 000 95. ETA, DEST r@TF(DATE/TIM'@); @100
97. OTHER Cgr@iMcN'TS-
FISN #: 0000/301 52. RON LOCI
57@ VALIDATED BY/REAS FOR '!.IGH@aR PRECEDENCE:
96, AIRCRAFT 'T-'@,N'ERA.PY: 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