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File: 102896_aug96_decls4_0029.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
PATIENT FILE 10130190
PERSONAL DATA - PRIVACY ACT OF 1974
5 U.S.C. 552 (b)(6) i3@ RODE@ A
18, AUTHORITY @'.; 03OIAOrz 2. SSAN@% 3. PRECEDENCE: P,
4. STAT@ All 5. CRADE@ E03 6. AG'c@ 25Y 7. SEXT I S. WT@ 240 9. READY DATE@ 301
1 (I. ism 'i@ POR2 1 12. SPEC C@AT: f
It
REAS RES: DS DATE LAST VISIT; 16. CLASS: la
'17@ ACCEPT PP@YSI 19@ A:PPi/SU'@6 DATE: NO
,u
20. APPROV ALITP@@ 21. CA C/IN.C- 22. VALIDT I JRL Y2
AN
23. litr' BRIG: A5150 USA DISPENSARY DHAHRAN 24. ICAO CRIB-. OEDR
25. @ITF DEST: F5070 liSAFRV,,'u Wi@-SEADE@'4 GE 26. ICAN@ DEST! EDAF
4 SE @,AuT@RE O' ANKLE
@7. i@c@D SPEC 1: SOO 28. DIA@Q 1: 8246 UNSPECIFIED CLn D FD
19. MED SPEU 2: 30. DIAG 2:
'@l. '@-ED SPEC 3-. 32, DIAG 3@
'Q2A. PROCEDURE@
T@@ k'@ i 34. IV@
. 02/LPiN: \,' 11 36. SLICT: N' @7. NG TL'Bct N' -)B. RESPT N' 39. FOLEY@ %I 40. STRYKER-, Ni
4'. 11\1cuB@ N 4'4. TRA,@i; N 43. !,MED: ii 44. CAST/LOC: N 4'0. TRA@'H; 46. MON: N
71, T BAB TYPEZ NE 7'L. PT BAB TAG 73. PT BAB '@T:
47@ S'L'-PP !NFL): FT BILL OK 16 CSP@
48. IMPY@ EN@'TE ST'u'PS: Y 1 9 49@ ,,AX 41 Y 1 9 50. Al T RESTIM.AX HT@ %,'
@3, !INPA
@3 ENT: Y 54. SPEC PROB2 VA DRUG ALCOHOL '-.4T NONE X 55@ VA CODE:
56. ADr@IN/Oki;RSEAS:
@s. VITA$- Slr-'i\S(T'-,M.P/PU'@SE/RL-SP/DiloOD PRc,BS)' 098.6 70 / 16 120 1 60
59. P@BB: 60. PCT: 6i. PBI,4; I DATE TAKEN:
62. @'.49C% 63@ SIIVSI; 64. Mc,DICP.T'40NS: NON'm
67@. E@@-T@RYt Tli,'IST-tD PA",NLE @4'HILE PLAYING coOTBP.LL.
66. ATT PiiYS@ N,C\@'E 67. OH#: 000 000 OOAIO 68. 14A,@RD /PHqt 000 O@,O O@00 0000
69@ RF-POOTP-D AY; tfiSBT F,@ARIN 70. PP,41: 000 0000
74@ AETEI\DAN'T I\AME 75. STA.TUST 76. GRADE:
77. 9,GE@ 72, SEX-@ 78A. @IT: 79. RELATIONSHIP TO PATIENT:
82. BAG t4T:
83. A l@iT@l\'T @A@-P #2: 24. STATUSZ 85. GRADE@.
66z AGET 87. SEXI 87A. WT: 98. RELATIONSHIP T PATIENTI
10
89@ BAB TYPE: 90. BAB TAB 91. R.Fj' WT:
9@,@ IRANS CRIB PHONE caT:
93. TRANS DEST EXT:
94. ETA CRIG LMTF(DATE/Ti@IE); 000 i 95. ETA DEST @FiF(DATE/T!V@E): 000
97. OTHER CO@,VEN Is;
,@l. imsn, @t 0000/301 52. RON '@OC:
57. VALIDATED BY/R@EAS FOR 'n'l@.ER PRECEDENCE:
@6. AIRCRAFT IT !NERARY: I f 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