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File: 102896_aug96_decls4_0018.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
03:55:21 PATIENT FILE 10/7@0/90
PERSC@NA'@ DATA - PRIVACY ACT CC i974
5 U.S.C. 552 (b)(6) 1'. VODE@ A
18, A@UTHN@ TY 0301AO30 2. SSANI: 3. PRECEDENCE@ R
RI
4. STA-; All PaRA.D--@ c 4 6. A07L: 22Y 7. SEXI M S@ @4T: 180 9. READY DAT ; 301
1 1 So IE
10. ISO@ 11. POR: 12. SPEC CATT
14. P@CAS REG: DS 15@ DATE LAST VISIT; 16. Cl@ASSt IC
ACCC ' PPYS: 19@ AP@0-II/SURB DA-E: KID
I AIPPROV AUIP@: @A I
@o. 21. - NC/'NC@@ 22@ VA!ID@ JRL I Y2
23. VITF ODIG-. A@1150 USA DISPENSARY DHAHRAN 24. ICAO ORIG: OEDR
2@@. imTF DES-ii A5030 FRA\'L',F'JRT ARMY OEC NED 0.6. ICAO DEST: EDAF
27. Vi'@D SPEC 1: @IPPG 28. DIAG 1: '@019 UNSPECIFIED P--.RSONAI TTY DISORDER
29. SPEC 2: 30. DIAG 2:
D SPEC 3: 32. DTApo 3:
32A. PROCEDURE:
33. SPEC DIET: N/ 34, IV:
35t 02/LP@'@: N' 36, SUCT: N 37. KIG TUEC: N, 38. RESP: N 39. FOL@Lyt 40. STRYKER: N
41. INCLIB: q 42. TRACT: N 4,@. IMED: i\' 44. CASI/LGC; @N' 45. TRACH@ N 46. riON: N'
71,@ PT BAG TYPE: NB 72. @i BAG TAG 73. PT BAG WT:
47@ SUPO TNFO, FT CAMPBELL 5 MASH
46. VAX ENRTA STOPS; Y / 9 49. MAX @ FruNS: Y 1 9 50. ALi REST/IIAX HT: N
INPATIENT: Y @lt.. SPEC PRO@@T VA DRUG ALCOHOL WT NONE X
@3. 55. VA CODE:
56. ADMITNIOVERSEAS:
53. VIT L SIGNS(TE@wiP/PULSEIRESP/BLOOD PRESS): 098.6 1 65 / 16 1 120 60
.A
59, HraD: 60. HCT,. 61, ABBT I DATE TA"EN:
62. NBC-. 63. SIIVSI@ 64, MEDICATIONS NORFLEXIN 400 MO P'UBID
6@@. HISTORYT PERSONALITY DISORDER EVALUATED BY PSYCHIATRIST. RECOMMEND PT BE
SENT DU] OF THE ACR.
66. ATT P4YQ-: NONE 67, PH.@i O@')O 000 0000 66. WPRDI/P@'-!,#: 000 / 000 000 O@100
69. REPORTED BY: MSr@i MARIIN 70. P?@#; 000 0000
DE:
77@ AGE: 78. Sc@X: 78A@ WT-@ 79. RELATIONSHIP TO PATIEN'TT
80. BAG TYPE: 81. BAG TAB 'q: 82. BAG @IT:
B'o@ ATiEN!DA\!T NAME @2t 34. STATUS; S5. GRADET
8'0. AGE; 87, SEX; 87A. ;AT-. 86. RELATIONSHIP TO PATIENT;
69. BAG TYPE: 90. BAG TAB 91. BAG WT:
92. TRANS N@RIS PHONE EXT:
93. TRANS DEST PHONE EXT:
?4. ETA ORTO MT@(DVIE/T!V@E)@ AIOO 95@ ETA DEST MTF(DPTE/T!VtE); 000
97. OTHER P@@i.MP-N IS:
51@ MSN 0: 0000/301 52. RON Ln@.-.
57@ VALIDATED BYIREAS FOR HIGHER PRECEDENCE:
96. AIRCRAFT ITIN'ERARY@ 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