Document Page: First | Prev | Next | All | Image | This Release | Search
File: 102896_aug96_decls4_0020.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
OZ,: 56: 00 PATIENT FILE 10/301'90
PERSONAL DATA - PRIVACY ACT OF 1974
5 U.S.C. 552 (b)(6) '3@ I'@ODE:
I A
1. @A,@IE! 18. AUTHORITY #@ 0302A@104 2. SSANT 3. PRECEDEN' : R
L@. STAT; All 5. GRADE:ll QE
-0 6. AG'ct 23Y 7. SEX: M B. 'w'T: 204 9. READY DATE: 301
io@ ISO; 11, Pu'@R: 1 12. SPEC CAT@ 1
14. REAS REG: DS 15. DATE "ABI VISII: 16. CLASS: 2A
17. ACCEPT PHYS: 19. APPT/S'dPG DATE: NO
20. APPROV AUTH@ 21. CA@iC/!N'@@ 22. VALID: I JRL Y4
2@ VITF ORTC, A5150 USA DISPENSARY DHAHRAN 24. TCAD ORIG-. OEDR
2@@@ NIT-- DES-1@ A503'0 FRANT,FURT ARMY RES DIED '@6. ICAD DEST: EDAF
1: SOP 28. DIAS 1-@ l@2801 HEMANIGIO@IA CF SKIli AND SUBCUTANEOUS TISSUE
29. i%c'D SPEC 2: 30. DIAS 2:
31. riED SPEC 3: 32. DTAG
32A. PROCc@DLIREt
3@ SPEC DIET; N/ 34. IV:
35. 02/LPri- N 36. SU.CTI l@ 37. NIB TUBE: N 36. RESPI N 39. FOLEY: N 40. BID KER:
i Ily
4i@ INCUB: N 42. TRACT: N 4'@@ I@IED: iN 44. CASi/l@OC: i% 45. TRACH: N 46. MON: N
71@ P7 '@RAB TYPE: NB 72. PT BAG TAG 73. PT BAB WT@
47. SUPP INFO: FT P@OOD TX 5 @,NIASP.
48@ FIAX ENRTE SIOPS: Y / 7 49, i@AX # RONS: Y / 9 50. N--T R@@971/rAX HT; N
53. P4PATIEl%'T, ",G: VA DRUG ALCOHOL N-1, NONE X 5@, VA P DE:
y q-4. SPE' PRL
L 10
56, A.DVli\'/DVERS--.ASt
58. VITAL SIG@IS(T--.1yiP/PULSE/RESP/BLOVu PRESS)I 098.8 78 / i6 90 64
59. uGB: 60. HCTT 61. ABG: I DATE TA@Z
62@ w'PC2 6-,. SI/VSI; 64, PERCOSET i-2 TABS PO r,14 PR,\'
G 4!ASS' , PLANTAP SURFACE BOTH FEET.
EXPLORATION' SHOIKIED FE@'.-ANrz'ICV.-A. NEED EVAC FOR '@/U AND EXCISION.
66@ PTT PPYS@ STE@IAR' 67@ 000 000 0000 6@ @IARD#/PH#-. 000 C)OO 000 0000
69, RT-:PCRIED BY@ 'IASGT MARTIN 70. PH,4: 000 0000
74@ ATTENDAi%i NAME #I: 75. STATUS. 76, GRADE-.
77. AGcl- 78. SEX: 78A. 14i; 79. RELATIONSHIP TO PATIENIT@
80@ BAG TYPE: 81. BAG TAG 32, BAG WT@.
B@@, ATTENDANT NAME 'k2: 94. S- Ugg 8@@. GRADET
I I AT
86. AGE: 87. SEX; 87A. L@.'T: 86. RELA-,T
,@ONSP,!P TO PATlEiNT!
89@ BAB T P-@: 90. BAG -, G 91. BAB @IT;
ly - @A
92. TRANS @URIC PHONE @t-. EXT:
9 . tRAi@'S DEST PHONE #: 1--YT:
94, ETA ORIS MTF(DATE/TlmE): 000 95. ET DEST MTF(DAT'C/lIr@-c': 000 I
.A
@IYF"Kist
51@ MSt@l #; 0000/301 52. RON LO'@;
57@ VALIDATED BY/REAS FOR HIGHER PRECEDENCE:
96. AIRCRAFT III" RARY:
, j@@
Document Page: First | Prev | Next | All | Image | This Release | Search
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