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File: 102896_aug96_decls4_0028.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
03:5S: PATTENI FILE
@@PEONA!,- DATA - PRIVACY ACT OF '974
5 U.S.C@ 552 (b)(6) 4
A '. 1 18. AUTHORITY #; O@02AO42 2. GSAtNv 3 . PRECEDENCE: R
4. Si@Ait All 5. GRADE: c@o'_) 6. AGE@ 22Y 7. Slq; M B. WT: 19c) 9. READY DATE; 302
io. To : 1'. P[jR; 'i2. SPE@ CAT:
I @.0
14, r,@AS REG: DS 15. DATE 'LAST VISIT@ 16, CL@ASS@ 2B
i7@ ACCEPT PF.YS: JYRC 19. APPT/SIJRS D.@TE@ NO
20@ AQPDOV RUip.@ 21. '@Ai\'@@/INC: 20-. VALID: B@m Yi
2'@. r;TF BR!BT A5150 USA DISPENSARY giARRAN 24. ICAO 'uIRIG-. GEDR
25. @TF DEST: A5040 2ND @EN @',GSP LAMDSTUHL 26. ICAD DEST: EDAR
27. @@,ED SPEC It ti'it 28@ DIAG 1: 7F,2 FUi\@',ETIC\AL AND LIND TAGNOSED CAF,,D'@p:, ViliRMLIRS
29. @ED SPEC 2: 0. DIAS 'L:
31. 11@@D SPEC 32. DIAS 3@
"A. POOP@EDURE;
3 . SPEC DIE'; Y/ NONE STATED 34. -@,Vz
35. 02/LPII; 0 36. SU@PT@ N' 37@ kt@ TUBE: N 38. RESO: 39. FOLEY: N 40. STRYKE@RT N
NCUB-, N 42@ TRACI; N 43. l@'@ED: Ni 44@ CASTI'@OC: 45. TRAC,4i iN 46. ViOiN: N
71. Pi BPS TYPE: ND 72. PT DAC TAG @t 73. PT BAG tC,,@
47@ SUPP INFO: B B-IRY 1/39T'@' FA T. @RA@@G, NC RFPGRTC@D BY
@16 CS7@
48@ MAY ENRTE STOPS: Y / 9 49. @AX @t RONS: Y / 9 ',O@ Al-T R'cSTI@l@AK Hit Ni
IC t- WT \.ONE X 55. VA, CODE:
INPATIENT: Y 54. SPEC PRfjG-, VA D@RUG A' U,@n
56. A@DMT
@.N/OVEIRSER@
58. VITAL S16N'S(TEMP/PULSE/RESP/DLDOD PR'CSS): 096.6 1 60 /!'I iliO 70
59@ HGD; 60. HCT@ 61. ABG@ DATE TA@@EN:
62. '@DC; 63, SI/VST- 64. MEDICATIGt%@6; MD'R'N gool@'ig -,TD
65@ @ISI-.0@RY2 PT ADViliTED 22 OCT P@X OF 'up,--ST PAIN' AND FI,UTTc,RIN@c, HOLIER MO
@ R
\-'!TOR SF.,DW@CD OVC'S AND @uL,.PLETS--POSS. @'EA@'T MLRi@L'@l. PT NEEDS EcHn@@@
DrGPz@P.ri AND TREADMILL STRESS TEST: IS NOT AVAILABLE IN TH TS TPEATER.
b6@ ATT P@
,YS; YOST 67. P' 000 000 000' 66. WARD#/PF@#.: 000 I 000 000 0000
69. REPORT D BY: DENTON' 70. Pd#@ 000 0000
74, ATTENDANT %]Afi-t 75. STATUS: 76. GRADE:
71@ 78. 67tXt 76h@. 'WT: 79. RE'@ATT@nNSUTP TO PATIENT-.
60. BAG TYPE@ 81. BAG TAG 82. BAG ',AT:
83. ATTENDANT NAME 4I.: 94. STATLIS@ 85, 6,RADEi
96@ AGE@ 67. SEX: 87A. 'AT: 89@ RELATIONSHIP TO PATIE;NTT
89. BAG IYP'Z: 90. BAG TAB 4@ 9i@ BAG WT:
92. TRANS CRIB PPOi\'cl E@T:
93. TRANS DEST PHON@C EXTT
94. ETA DRIG MT (DATE/TlriE)@ 000 95. ETA DES'-, MTF(DAT@/TIV.-E); 000 I
.F
97, OTF@EO COMMENTS:
@@l. MSi\' #: OL@00/302 Yz. RON '@oCi
T
57. VALIDATED BYIREAS FOR HIG@ER PPECEDENr@E,.
96@ P.TR@@RAFT 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