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File: 102896_aug96_decls4_0025.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
O@ 57@19 PATIENT FILE 10/30/90
PERSONAL DATA - PRIVACY AC] OF 1974
5 U.S.C. 552 (b)(6)
i3. ivCIDE: A
1. N'Atic,2 'S. AUTHORITY #: O@3On4A@139 2@ SSANI 3. PRECcJ;-NICE@ R
4. STAT: All 5. GRADE: E06 6. A@oP-@. SnY 7. SEX: t4 S. @iT@ 208 9. READY DATE: 302
10. ISO; li@ POR@ I 1 12. SPEC CAT:
14. REAS @REG: DS i5. DATE LAST VISIT: 16. CLASS: 3A
17. ACCEPT PVYG: J'ili@D 19. APPTISUPG DATE: NO
20. APPROV AUTH: 21. 22. VALID: B..Il Yi
23. MTF DRIG: A5!50 USA DISPENSARY D@,A@'.RA@N' 24. ICAD ORIGT CEDP
23. riTF Dc,St@ A5040 2ND BEN @'..OSP i-Ai@DSIL17@L 26. !P.AG DEST@ EDAR
27. ?iED SPEC I @ @IMC 28. DIAS 1: 786@10 UNSPECIFIED CHEST PAIN
1,
FT- CHEST PAIN
la
@'i-,D SPEC 3; 32. DIAS 3:
32A. ?RC-Cu.DURE@
3 , SPEC DI'CT- Y/ NONE STAIED 34. !V@
02/LPVi: N136. SUCT: N 77@ N@ T BE: N 3S. RES@D@ t@,' 39. FOI Y. @i 40. STRYKER: K,
Ql Q lu @E
41, INCUB:N 42@ TRACT: i@' 43. N' 44@ CAST/LOC,. N 45. TRACH: i%l 46. M@ON: iN
71@ PT Zi.40 TYPE@ NB 72. PT RAG TAG 7S. PT BAG WT:
47. SI@'PP INFO: DUSTA- 2/-,,3RD T AN'S CO; FT. BLISS, TX REPORTED BY
@R
5 ;'O.,ASL.1
48. FLAX ENRTE STOPS: Y / 9 49. ?iAX 'q ROINS; Y/ 7 50@ ALT REST/@tAX HT: N
Y 54. SPEC PROG: VA DRUG ALCOHOL 55. VA u'ODE@
@IT IN'C\'C X
56@ ADMIiN/GVERSEAS:
58. VITAL PRESS): 096.4 I' 68 f iB 122 90
59. 60. HCT: 61. ABB@ 11 I DATE TA@EN:
11 TTON
@Ly 06F.RS/ilITRO
G@ CC IN @)@7 - O@4ViCS SUPLIN@@ AL PR%' PAIN
LY @R@ I ou
65@ HISTORY: 32YO IL.'YI 4'/INTERMITTENT CHEST PAIN, X2@4KS. ABNORIMAI, EKG W/ST W.AVESN
ELEVATION' LEADS V-@@ & V-3. CARDIAC EtdYr,,ES; WNIL. ri NEEDS TRc@ADriTLL TEST
66= AT-i PHYS- 67. PH#: 000 000 0000 69. WARD#/PH#: (100 f 000 000 0000
69. REPORTED BY: DENTON 70. PH#: 000 0000
74@ ATTENDANT NA@IE #I: 7@'. STATI@'s@ 76. GRADE:
77. AGET 78@ SEX: 76A. WT: 79. RELATIONSHIP TO PATIEN-i:
80. BAG TYPE; Si. BAG TAB #t 82. BAG WT,.
83@ ATTENDANT NIA,4.E #2: B4. STATI,16: 85@ GRADE:
86. ABE: 97. SEX: 87A, ',,@T@ 88. RELATIONSHIP TO PATIENT:
69. BAG TYPE@ 90. BAG TAB 91. BAG 6'T:
92. TAN'S ORIG PHONE EXT;
93@ TRANS DEST PHn.rNI@:
94. ETA @',TF(DATE/TltlEli 000 9@@@ ETA DEST @ITF(DATE/TIME): 000
. @t1
97. OTHER COVinNTEi
@ll= NSN #,@ 00001302 52, RON LOC.
EDENCE:
96. ATRCRA.F- Tyl,@'cRAD
i,Y
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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