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File: 102896_aug96_decls4_0021.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@56:17 PATIENT FILE '0/30/90
PERSONAL DATA - PR'VA@@y ACT OF 1974
5 U.S.C. 552 (b)(6)
13, MOD-t.- A
1. IJ.AME- M 18, AUTHORITY #@ 0302AO46 2. SEAN: PR'UEDEi%!CE@ R
4. STAT: All 5. GRADE: EOS 6. AGE: 4UY 7. S'CX: iM 8. @'AT: 2iO R@@ADI DATE: 302
10. 'ISO- 11. POR: 12. SPEC CAT:
14. REAS REr@: DS 15, DATE LAST VTSIT@ 16. CLA'--Sz 2B
17. ACCEPT PF@YS: JMRO 19. AF?T/SliRG DATE: NO
20. APPEROV AUTH@ 21. @ N,C/TNC: 22. VAIID@ BIM I Yi
'A
2-6. i@'@TF OR!GI V@150 USA DISPENSARY DHAHRAN 24. ICAU ORIG: OEDR
25. IMTF DE97t@ A@@040 2ND SE@N P.OSP LA@@,SILIHL 26. TCAD DEST: EDAR
27@ rED SPEC 14 i@FC 20, DIAS 1: 4279 CARDIAC DYSR4YTPNIA, UNSPECIFIED
29. M-,D SPEC 2i @APC 3A@. "IT AG 2t 4279 CARDIAC DYSRH.YTH,@IIA, UNSPECIFIED
31, @IED SPEC 3@@ 2. DIAS 3:
32A. PROCEDURE:
TED 34, TV:
35@ 02/LFM: N 6. SU@@T, N 37. @Nu@ TUBE: N' 38. RESP: N 39@ FOI,EYT N' 40. STRYKER; N
41 TNCIJB. N 41@, TRACT: N 4.3. !MED: N 44, CAST/LOC; N 45. TRAZH- N 46@ MO,\': N
71. PT BAB TYPE: ND 72. PT BAB TAB 4i 7'@. PT BAB t@,IT:
47. StiPP li@FG: !OIST C63 FT. KY REPORTED BY
28 C@'.
49. itAX E,4,RTE S7]0r'S: Y / 9 49. @,AX # RONS: Y / 9 50. ALI Rc@ST/V@AX 4T: N
INPATIENT; Y 54. SPEC PROS: VA DRUG ALCOHOL WT NONE X 5@'. VA CODE;
56. ADMI\I/GVERSEAS4
@g. VITAL SIGNS(TEViP/PULSE/R@USP/Bi-OOD PRESS): 078.4 64120 liO 1 82
59. HBBI 60. P@CT; 61. ABG: I I DATE TAKEN-
62. IAIBC@ 6@,@ SI/VSI: 64@ @i'DICATIONS: LOPRESSOR 50MOS QD/ASA OD
65. HISTORY: DT HAD iM! ON AIR EVA@@LIATIO.%' FLISH.T TO GERMANY X2wKs AC-0. PT WAS RC
S"LATEN, TO LANDST Fj
iu @ AR@iY REGIONAL MEDICAL CENTER Ai@'D WAS RETURNED To DUTY WI
IHQ'J-I EVALUATION. PT htc-@@DDS A CARDIAC CAT@ERIZA TT ON AND HOI.TER t4ON
IIDR PROCEDURE. **-;HIS PATIENT IS NCT-I TO BE RETURNED io DUTY 147THOUT THESE
IESTS BET@\16 DONE**
66. A-IT PHYS@ YOST 67. P.q#: 000 000 0000 68. 'w'ARD4/PH#,. 000 f 000 00 0000
69. REPORTED BY: D@cNTONi 70, PH#: 000 0000
ME #I: 75. STAIUS@ 76. GRADC@-
77. ASE@ 78. SEX; 78A. I: 79. RE@ATIGIN'SHIP TO PATIrli@Tt
80. BAG TYPE: 31. BAG TAG 62. BAG WT@.
83. ATIENDANT N4.rlF 411: 84, STATUS: 8'0. GRADE:
C6. AG'-Z- 87. SEX: 87A. WIT: 88. RELATIONSHIP 10 PATIEN'TI
89, BAB TYPET 90, BAG TAG 9'@. BAG WT:
92. iRA.,'q'S ORIG PHONE EXT:
93. TRANS DEST 4: EX':
94@ ETA ORIC ?t-,-F(DA.TE/Tl E). O@ 93. ETA DEST rl-IF(DATr, /T 'VE): 000
97. Gi'@EP, COMMP-NTS-
3i. MS@N #; OOOA@/302 52. RC,%' LOC:
57. VAITDPTE BY/REAS FOR HIGHER PREC@ c@i\'CE:
-. D CD
96. A-RP@RAFT IT-INEPARY:
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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