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File: 102896_aug96_decls4_0023.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
03:56:47 PATIENT FILE 10/30/90
ERruk'Al- DATA - PRIVACY ACT OF 19i4
5 U.S.C. 552 (b)(6)
13. @'iODE: A
1. '8, AUTHORITY #@ 0302AOO2 2@ SSANI: 3. FRE@CDENCE: R
4. ST -I- A" GRADE: P-04 6. @@@E: 22Y 7. SEX: M 8. WT: 140 9, READY DATE: 301
iAi L
10. ISO-. 1'. @OOR,. 12. SPEC 'uAT:
@4. REA.6 REC. DS 15. DATE LAST VISIT: '6. ASS: 2D
17. ACCEPT PHYSZ 19. A..PPTISURG DATET NO
20@ APPROV AUTU: 21@ CANC/!N': I
42. VALID: JRL Y4
23. r@TF OR16i A5'50 USA DISPENSARY DHAHRAN 24. !CAO DRIG: OEDR
25. MiF DEST: A@1040 2N'D S'mN' 'F,.'O'mp LAIDSTDHL 26, IC.40 DEST: EDAR
FMi%, 2B. DIAG 1: 7607@ CONVULSIONS
I 'iq.ED SDEC 2; 30, TJ"AS 2;
3'L. tvED SPEC 32@ DTA6 3-,
30@A. PROCEDURE:
3--,. SP'-IC DIET: iN/ 34. IV,.
35, 02/LPM: N 1 36. SUCT- N --@7. NB TUBE: N 38. RESP: N 39. FOLEY: 14 40. STRY ER: N
41. INCIJD.@. N' 42. TRACT: N' 43. 1,4,ED; N 44. CAST/LC@-; iN' 45. @RACH: N46. MON: N
71. 01 BAG TYPE: NB 72. P' BAG TAG 73, PT BAG @'Tt
47. SLIPP INFO@ FT STE@IRRI 6,A 5 MASH
4S@ MAX ENRTE 67j'GP@ Y / 9 49@ VAX @ RONS: Y / 9 50. ALT REST/MAX H T N
1
53. INPATIENT- Y 54. SPEC O.ROG@ VA DRUG ALCOHOL 4T NC-NE X 55. VA CODE:
56. AD,'Ilh'/DV'cRSEAS@
c
56. VIIA!- SICkIS(TEIIr@IPULSE/RESD,IBLOOD P-RISS)Z 104.0 104 / 14 / 98 @@o
59, HOP: 60. FCT. 61. ABB: DATE TA!EN:
62@ NBC: 6 . SI/VS!: 64. @-"i---DICATIONS: TYLENOL 325 MC 1-2 TABS 06u
6@'. HISTORY: POSSIBLE SP-IZUPES.
000 00'v 000 0000
69@ REPORIED BY@ IVISCT MAD R'
. ART @ 70. PH#: 000 0000
74, ATTENDANT Pl@ 75. STATUS4 76. GRADE:
77. A,'Up: 76. SEX: 78A. v,'T@ 79. R-tLATION@@HIP TO PATIENT:
80, BAG TYrrE-@ @91.2
T 82. BAG '@T:
,A,
876@ ATTENDANT NAME #2: 64. STATUS: 85. GRADE:
6. Aric'; 87. SEX! 87A. WT! 88. RELATIONSHIP TO PATIENT:
89. BAG T P 90. BAG TAS 91. BAG INIT@
'Y' E
92. TRANS ORIS PHONE 4i c,XT:
93. TRANS DEST PHONE #: EXT:
94@ ETA CRIG tITF(n,ATc@/TIME): 000 95. ETA Du T iytTF(DATE/TiriE); 000
i.
97- OTHER COMMENTS:
@ I
MSN 00001301 52. REIN LOC:
57. VALIDATED BY/REAS FOR 4I6HER PRECEDENCE@
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