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File: 102896_aug96_decls4_0027.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
03i57@j2 PATIENT FILE ',0130/00
PERSONAL DATA - PRIVACY 4r@-I OP 1974
5 U.S.C. 552 (b)(6)
13. riDDE: A
.1
16. AIJTPG @.Y #: 0302AO40 2. PRECEDEN@,E@ R
1. NAN'; RIT SSAN: 7.
4@ S@'AT: Ali J. GRADE; c@03 6. AGE: 46Y 7. SEX: I 8@ 'A!Ti 175 9. READY DATE; 302
10. ISO; 11@ POR- 12. SPEC CA I:
I
14. REAS DE6: DS @5@ DATE LAST VISIT: 16. CLASS: 3A
i7. ACCEPI PHYS@, JMRO 19. APPTIS@IRG DATE: NO
20. APPROV AUTH- 2i. "PNC/IN@@g 22. VAI@ID! I BM Yi
23. MTF ORIG: A5150 USP, DISPENSARY DHAHRAN 24@ !CAO ORIS: OEDR
-6. ICAO DEST: ED@R
,F @o
27: t@ic-D SPEC l@ riili" 28@ DTAG ': 4139 OTHER AND U-NSPECI'IED ANGINA PE'UTORIS
29@ @.ED SPEC 2, 30. DIIC 2@
1. "ED SPEC 31. @2@ DIP@C@
32A. PROCEDURci
,,3. SPEC DIET: Y/Nn@N-r STATED 34. !V@ 1
3i. 02/1@PM: ti1 36. Siri- K., 37. Ng TUBE@ N 38, RESF: N 37. FOLEY: N@ 40. STRYKER: N'
41. Tik,@IJB: KI 42. TRACT: N 43. IMED: N 44. '@AST/LGC: iN' 45. TRACH: N 46. m N: N
71. PT BAG TYPE. NB 72. PT BAS TA'u 73. PT BAG @IT:
47. SUPP liNFD- 13TP, COSCOM; "IP. @T@ HOOD, IX REPORTED BY
28 '@GH
48v r'@,AX ENOTE STQPS: Y / 9 49. i4@AX Y 9 50@ ALT RESTIM.AX HT@ iN
51@. Y @@4. SPEC PDor@: VA DR 6 ALCOHOL V@T NONE X 55. VA, CODE:
@6. ADMIN/'uV@ ic@AS:
5@ Vil@L S'CNS(TEMP/P'u'LSE/R---SP/BLOBD PRESS): 098.6 68 16 1,8 / 68
@9. R6B: 60. HOT: 61, AEG: I I DATE TAKEN:
6'z. NBC: 6--,. SI/VSI: 64. MEDICATIOIv.S: !SORDIL 10,M'us TID
65. V@ISIORY: 46YO Vil?, W/HX OF ANGINA- @i@nie IN FAST 2 @IKS LISUALU G@@.1 EXERTION AND
SOMETI,N'ic@s AT REST@
/PH#@ 000 I 000 'VOO 0000
69v REPORTED BY@ DENTON 70. PH#- 000 0000
74, ATTENDANT NAI@E @l: 7@@. S-IATUS: 76. GRADE:
77. AS@t 7B. SEX-. 78A., @IT: 79. RELATIONSHIP TO PA.TIENT@
GA. DA'.s TYPE- 81. BAG -@p@G 82. DAG @,iT@
83. ATTENDANT NA@M.E 42- 84. STATLIS,. 85, GRADE:
66. AGE: 97, SEX: 87A. 1,4T: 88. RELATIONSHIP TO PATIE.Nii
69. BAG TYPE: 90= BAG T 6 91. BAG tiT:
,A
92. -@IANS ORI@. PHONE #i EXT:
93@ TRANS DEST PHONE #z EXT;
94. ETA ORIG MTF(DATE/TlilE); 000 95@ ET DEST MTP(DAT /TIM'): 000
,A @E
97@ OTHER C@@,viMENIS:
51@ MSN' #-. 00001302 52. RON !-GO:
5-/, VALIDATED BYIREAS FOR HIGHER PRP.CED-'-Nl@,'E:
96. AIRCRAFT ITINERARY: I
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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