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File: 102896_aug96_decls4_0017.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
03:55:07, **** PATI-'-@%,t ri'@E **** ifi/30190
PERSONAL DATA - PRTVAP@Y ACT OF 1?74
5 U.S.C. 552 (b)(6)
i3@ MODE: A
1. NAME: 18@ AUTHORITV O,-@O2@4003 2. SSPN: 3. PRECEDENCE: R
4@ STAT; All 5. GRADE: P-04 6. AGE; 21Y 7. SEX: @r B. WTi 112 9@ READY DATE: 301
io@ ISO: P.D@- 1 12. SPEC CAT:
71. I
14. REA.S OES@ DS 15. DA E LAST VISITZ 16. CLASS: '@B
AT
17. ACCEPT PHYS: 19. APPT/SURG DATE@ NO
@o. AP@DROV AUTH@, 21, @,Ai\l@@/'\'C: 22. VALID: 'RL Y4
23@ t,'iTF OR'G: AE,150 USA DISP-LISPRY DHAHRAN l@4. ICAD C@RIB: OEDR
26. !CAO DEST: c AF
.,F-R. ED ED
27@ Mc@D SPEC 1: 960 28. DIAS l@ 64300 Vi'LD HYPEREM,'@SIS GRAVIDARUR(, ABORTIVE OUTCOME
29@ i@-ED SPEC 2i 30@ DIAG 2:
3'@ i"iED SPEC 3 -. 74@ @ DIAG
'@2A. PROCEDURE;
3'. SPEC DIET: NI 34, IV:
7,5. 02/LP@@ N 36. SLICT: N' ',<7. NS TUBE: N 38. DESP: 39. FOLEY: N 40,. STRYKER: N'
41. iN'C'JOI: N 42. TRACT@N 43. !F@.ED: %I 44. N 45. TRACPI: N 46. rON: N
7'. Pt BAG -@y@"E: NB 72. PT BAG TAB &: 7'@ PT BAG @4T
47@ BURP li\!Fo: FT BLISS TX 23 ATP,
46@ MAX ENR-IE STOPS: Y 9 49. VAX @ RONS: Y / 9 50@ ALT REST/MAX HT: t@ 1
53. INPATIENT: Y 54. SPEC PROG: VA DRUG ALCOHOL @'T NONE X 5@@. VA CODE:
ADI@ilN/GVERSEAS:
58. VITAL SIGNS(TEMP/PULSE/RESPIBLOOD PRESS)@ 098.4 68 / 16 122 1 60
59@ HOD; 60. HCTT 61,. AEG- I / DATE TAKENT
6@ g-/VSI: 64, MEDICATIONS: PHE@IERSAN' 25 riG 04 PRN' (IV)
65. HISTORY; 3 WEEKS PREGNANT W/ HYPERER,,ISTS GRAVIDARUri, REQUIRES IV FLUID.
6. ATT PH.YS: TH---@ViPSON 67. PH#: 000 OAIO 0000 68. WARD#/PH#: O@O i 000 CO() 0000
69. REPORTED BY; Y,-@'@3T 70. PH#@ 000 0000
74@ AT
,Tc,NDAiNT NAME #I: 75. STATUS: 76. GRADE:
77. AGE,-. 78. S-qt 78A. WT: 79, RELATIONSHIP TO PATIENT:
80@ PAC TYPE: 81. BAG TAG 't: 82. DAG WT:
876 @PTT @\tDAN'@ NAME @-2@ 64. STATL[ST 85. 6RADEt
,E I
8'a@ AGE: 87. SEX: 87A. Wli 88. RELATIONSHIP TO PATIENT:
89. BAD TYPE: 90@ BAG TAB 91. BAD @'T:
92. TRANS ORIC PHONE f,: EXT:
97@. IRAI\,S DEST PHONE 4t EXT:
94. ETA @ TG Vi@F@DATEITI@,E): OOA 1 9@. ETA DEST hTF(DAT'/TIViE): 000
uR@i c
97. OTHER COVi@,IP-NTS@
52. RON LOC:
D @E 1
;)7. VALIDATED IiY/REAS' FOR HTSH.ER P@RECC ENP i
96. AIRCRAFT ITINERARY:
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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