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File: 102896_aug96_decls4_0031.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: @@9:,I)7 PA-,@IEN'.-, @ILE io/@@0/90
PERSONAL DATA - PRIVACY ACT OF i974
5 U.S.C. 552 (b)(6)
iMODc: A
l@ @AVF,: I 18. AUTHORITY 'tt 07)02AOO7) 2. SSANI: 3. PRECEDENCE: R
4. S-IAT: All 5. @oRAD@@ E(14 6. AGE: 22Y 7. SEX: M S. t4T@ 150 9. READY DATE: 301
10. '-So: It. POR: 12. SPEC CAT:
14, REAS RES. DS 15. DATE LAST VISIT: 16. CLASS: 3A
17@ ACC-IPT PPYS@ 19. APPT/SliRG DATE: KID
20@ APPROV AUTH,: 2i@ '@ANC/iNC! 22. VALID; I JRL Y4
2'@. !@@TF OR'C-, A5150 USA DIEP'LINEADY DHAHRAN 24. ICAD OR TG: Oz'DR
25. l@'iTF Dc@671.2 F5070 LISAFRiytC WIESBADEN GE 26@ !CAO 'LIES-ii caAF
27, @.-ED SPEC 1: SSU 26. DIAS '@ 5997 FEVIA[URIA
'9.
z @iED SPEC 2: 30. DIAG 2%
MED SPEC 32, DIAS 3@
'2A. PROCEDURE:
N/ 34. TV@ I
@5@ 02/L@ii-@ K- 36. SUET: N 37. NG TUBE: @l 36. RESP: N 39. FOI@EY@ iN 40, STRYKER: N
41. INCUB. N4'4. IRACTI 47,. 'I@iED: N 44. @@AST/LUC: N 45. TRACH: N 46. il",N: N
71. PT BAB TYPE: NE 72, Pi BAB TAG fi 73. PT BAB WT:
47. SUPP INFOI FT BRAGG NIC 5 MASH
48@ MAY ENRIE STr@'PS: Y 9 49. mAX 4 RO@S: Y / 9 50, A'@i REOJIM.AX HT; N
5-). 'NPA-,IIENT@ Y 54. SPEC @OROC: VA DRUG ALCOHOL WT NONE x 55. VA CODEI
@6. ADiMINIUVERSEP.S-.
@9. VITAL SIGNS(TEMP/PULSF/RESP/BLOOD PRESS): 096.4 60 / 16 130 / 92
59. PBB: 60. HrT: 61. ABC: I DATE TAKEN:
62. NBC: 63. SI/VST: 64. ,MEDICATIONS- NONC
'5. @,IST' F7 @RES
c CRY; GROSS H'ZriA-IURIA X 2 YEARS, INTERVTITED !VP SUDOPTIVUi\t R OUT
IBLE ABDOMINAL UliRASOUND,
Q-RO'@croIC 'WOOKLIP TO !NCL:L[Drl CYSTOSCOPY, POSST
66@ A,-IT PF.YS-. DU70,%-) 67. P@H t 000 000 0000 68. @IARD#/PH@: 000 000 000 0000
69@ REPORTED BY; @IEG7t MARTIN 70. OH4; 000 0000
74, ATTENDANT NAME #I: 75, STATUS: 76. BRADE@
77. AGE; 76. sclx: 78A. WT@ 79, RELATIONSHIP TO PATIENT:
P-0. BAB TYPE: 81. BAB T G B2@ BAB L@T:
,A
8--, @ATTENDANT NAME 42: 84. STATUS: Fa. GRADE:
86. 87@ SEX: 87A@ WT: 68. RELATIONSHIP TO PATIENT:
99. BAB -TYPE: 90@ BAG TAG 91, BAG
92. IRANS GOIG PHONE EXT;
93. TRANS DES-,, PHONE EXT:
94. ETA DRIG %J@T F(DATEIT@E); 000 95@ ETA DEBT MTF(DATE/TIM@E): 000
97. OTHER COMMENTS;
51. MEN, 1: 0000/301 52. RON' LO@l:
57. VAL'@DAIFD BN'/R-LAS FOR HIGHER PRECEDENCE:
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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