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File: 102896_aug96_decls4_0022.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
07,@56@32 PATIENT FILE 10/30/90
PERSONAL DATA - PRIVACY ACT OF '974
5 U.S.C. 552 (b)(6) i3, @MODE! A
NAME: 18. AUTHORITY 0301AO22 2. SSAi%lz@ 3. PRECEDENCE: R
4@ 9-tAT@ Al' 5. GRADE: EOS 6. AGE-. BY 7. SEX: @i 6. WT@ 140 9. READY DATE@ 301
10, 160; it. POR; 12. SPEC CAT @ 1
14. REAS OEG: DE 15. DATE LAST VI@IT@ '6. CLASS: 2B
17@ ACCEPT FHYQ-: dFiR'@l 19. APFI/SURB DATE: NO
20. APPROV AUTH: CAN@@/INC; 22. VALID; I I JRL Y9
2-@'. t"iTF ORIE@ A5,50 USA DSPEN&ARY DHA.1.RPN 24, 1CAPi ORTO: GEDR
L5. i@,TF DEBT: c5O7O 'JEAFRiM@@ WIESJADEN GE 26@ ',CAO DESTT EDAF
17
I'@ M-ED SPEC 1: SOn, 28. DIAS 1: 7'783 OLD DTSD@UPTT@, Fr ARIERIOR CROCIATE LIGA T
29@ ri-@D SPEC 2@ 710@ DTAG 2;
31@ VIC@N, SPEC 32, DIAS 3:
@2A. PROCEDURE:
34. 'V: I
@5@ 01@/LPi"ii I SUCT@ iN 37, NS TUBE@ li 36. @,s@1): N 39@ FOLEY-. ki 40. STRYKER: N'
41@ TN'LuLq: N 42. TRACT; N 43. 1,@-'-D: %'@ 44. CASI/LOC: N 45. TRA@,H@ %I 46. MON,. N
71@ PT BAS TYPE: NB 72, PT BAG TAG 4: 73. PT BAG WT@
47c SUPP INFO: D '@ 3/504 TKi- FT BRAGG, NC REPORTED BY
CHAMPION MAIN
48. @'P.X ENRTE STOPST Y 1 9 49. ilAX @t RONS: Y / 9 50. ALT RES-I/,MAX HT: N
T
i\?ATI'cr%"Tt N 54. SPEC PR'u'Gz VA DRUG ALCOHOL viT NONE X 5@@. VA COD7--:
56. ADii@i\'/GVERSEAS:
58. VITAL SIGiN'S(TEr(P/PULS--@/REEP/BLO07L? @@RESS)@
59, HGBZ 60@ HOT; 61. A@G; DA T TAVr-:Nl:
@E
62. NBC; 63, SI/VSI: 64. @IPDICATIO,@'S: TYLENOL 4 'ADS PRIN FOR PA.!NL
65@ HISTORY: ACL LEFT lq,'EE. PATIENT NEEDS SLIRGICA@ INTERVENTION AND PROLONGED R
EPA TIITA7TL'i%l OF 6 - 12 MoiNT S DEEIRC TO HAVE PATIENT RETURN TO FT BR A
@B@- It i4 I @@05.
64,. ATT DpvS@ 0,A@ COMPTON 67. PH.#: 000 000 0000 68. WARD#IPHtt: 000 000 000 0000
70, PH#: 000 OOAIO
7t,'@ AITENDAINT NAME #1@ 75, STATUS: 76. GRADE;
77. AGE! 78. SEX: 78A. WT: 79. RELATIONSHIP TO PATIEtN-1@@
80. BAG TYPE: 81. BAG [AS 62. DAB @'Ti
83. AiTEi\'DAi'iT NAME #2: 84. STATUS: 8@@. GRADET
86. ACcl@ 87. SEX-. 87A. @lit 88. RELP.TIONS.@'IP TO PATIENT:
89. BAD TYPE@ 90, BAG TAG 91. BAG ',,'T-
92@ TRANS OR!6 PHONE 0; EXT:
9-). TRANS DEST PHONE EXI-
94. ---@A CRIG MTF(DATE/Tl@1E)-, Ot)O, 95@ ETA DEST ,NTF(DA.TE/Tl@'@E); 000
97. 07i'd'aR 'Uorl@'icNTS:
51. @ISN. 1,A@: 00@@/301 52. RON
57. VA'@IDAT@CD BY/REAS FOR HIGHER PRECEDENCE:
96. AT RCR AT TTINE@@APY:
@F @
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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