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File: 102896_aug96_decls4_0030.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
PATT@ FLE '0/30/90
PERSONAL DAT A- PRIVA ACT OF 1974
. I @ICY
5 U.S.C. 552 (b) (6)
13. r.,GD'C: P,
NAME; 18, AUTHORITY #: 03OIA034 2. SSA@NT 3@ PRECEDENCE: R
4@ STAT-. All 5, CRADE: c@04 6. AGPT 23Y 7. SEXI M B@ WT: 220 7. READY DAIE: 301
10. ISDI 11. PORT I 12. SPEC @PA-1: i
14. REAS RES@ DS 15. DATE LAST VISIT: 16. CLASS; 2B
17. ACCEPT PuySt 19. APPTIEURC DATE; NO
20. 4.PPFCV AUTH.: 21. CA,.\C/INC; 22. VALID: JRL Y2
2'Q@ 11,@TF BRIG: A5150 USA. DISPENSARY DP.AhRAti 24, ICAO CRIB-. GEDR
@s. @'@TF DEST: A5030 FRANKFURT AR@IY REG MED 26. IP@AG DESTI EDAF
27. oy.'@D SPEC 1: SOD 28. Dlka It BL382 CLOSED FRACTURE OF UNSPECIFIED PART OF FIBULA @ITH TIBIA
29. @,.ED SPEC 'L: 30. DIAG 2:
@l. F,@ED SPEC 3-. 32. DIAG 3:
-@2A. PROCEDURE:
34. IV:
@T
35. 02/LPil: 36. SLIU'I : N 37, NG T BE: N 38, RESP: t%i 39, FOLcly: @14 40, STRYKER: N
.u -
41. !NCIJB. N 42@ TRACit %I 4 . !MED@ N 44. CAST/LOC- tl @15. TRAC.@'@. 46. MON: N
7i@ PT BAG lyPE: @%!B 72. PT SAO TAB 4; 7'@ PT BAG 6T:
47. SUPP INFO: FT P@OOD IX 28 CEH
48. MAX E@,RT,
@,c STOPS: Y / 9 49, MAX # RONS: Y 1 9 Al@T RESTIM.,A.X HT: t@
,!PA@T E,-%T i Y 5'@ SPEC FROG: VA DRUG ALCOHOL t4T iNt@'Nc X 5@. VA CODE:
56. AD,@"N',/CVERSEAS:
56. VITAL STS@\JSIT MP/PLILSE/Pu
@E. ,SP/BLnGD PRCSS': 099.4 64 / 16 122 80
,j,zp I I DATE TAKEN:
60, HCT: 61@ ABGT
62. 63, SI/VSI: @-4. rlc@DTCATIONS-, DErtr@'RAL @10 MG PO 4H PRN
65, HISTORY@ PT TOOK A DIRECT BLO@' 26 O@@@ 90
66. Al-,, PHYS: NONE 67. PP,4: 000 000 0000 68. WARD#/PH4; 000 I 000 000 0000
69. REPORTED By: MSGT MARTIN 70@ PHt: 000 0000
74@ AiTEiNDAsNT NAME @l@ 75. SIATUS: 76@ GRAT,'E:
76. SEX: 78A. @i: 79@ RELATIONSHIP TO PATIENT:
80, BAG TYPE: Bl@ BAG IAra #I 92. BAG WT:
83. ATTENDANT 4@2, 64. STA.TUS@ 85. GRADE-.
86. AGE@. 87. SEX: 87A. WT: B& RC,LATIGiNS,@IP TO PATIENT@
89. BAG iypc@: 90@ BAG TAB 91@ SAO
92 TAINS BRIG PHONE 4: EXT;
93. TRANS DEST F@HO'%'E EXT:
9A@ ETA BRIG imTF(DATEITI@ME)i 000 1 95, ETA DEST MTF(DATE/TIME)@ 000 f
1
97. OTHER
51. 4: 0000/301 52. RON LUC;
57@ VALIDATED BY/REAS FOR HIG@4FR PFFECED'c@N'CE-.
96@ AIRCRAFT ITINERARY: I I 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