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File: 092396_aug96_decls28_0001.txt
Page: 0001
Total Pages: 7

Subject: PATIENT FILE                                                    

Box  ID: BX000482

Document Number:          1

Folder Title: MEDSTAT - SITREPS  DEC 90  4 OF 6                                                               

Folder Seq #:          8

Unit: ARCENT      

Parent Organzation: CENTCOM     




                 Cl@_:j :24                                                          PA,-, IE@,'T FLE                                                      12 !'-?9/90
                                                                       C ELINAI DATA       PRIVACY
                                                                 PER
                                                                                                             4C OF '974
                                                            5 U.S.C. 552 (b)(6)

                                                                                                                                                     I'@.  MOD,'I A
                                                                                                                                                     3.    PRECEDENCE: R
                                                                         18. AUTHOR! I y         '@.t 0359AOi7 2@ SSP.N:@
          4.  STA.-i.   Al'                 5. C@OADt-i @c@)6             6. AGE. 4@jY                       7. F@X! ill    S. WT.-      2i2         9.    READY DAi:: 359
                                            11. FOR:                                                                                                 12@   SPEC 'uATt
          14. R7=AS  'REG@ DS               15. DATE        'LAST 111SIT:                                                                            16.   CLASS: 3A
          '7. ACCEPT PHYS;            u'@'IPO                                                                                                        l@.   APOT/SURG DATE; N,'Ll
          @-)O. AP@@,,iGV AUTH:                                                                  21.         CA@4'@U/INC;                            22.   VALID:                    RINS. I YS
                                                                                                                                                           A-               -DP,
    2'@. t-1-7r RRI@ .4@1150          USA D'Z'. ER,'SADY D,9A.4.RA@l                                                                           24.   I.,- n op,18;    or:
          2i@ M'LF DEST; 4jO4O              2@D GEN HOSP LA,@liDSTLIP.L                                                                              26.   ICAO DEST:       EDAR
          21. riED SPEC 1: @!@c             'IS. DIAS 1:    4149       CHRONIC ISCHc@i4ilC HEART             DISEAF-,  UNSPECIFIED
          29. M-tD SPEC 2, SSP@A            30. DIAS 2:     4149       CHRONIC ISCPEMIC HEART                DIS-,ASE,  liiN--iPEr@IPI-tD
          31. @4'@ED c-zpg-:c 3! APC        32@ DIAS        3i 4149    CHRONIC !SCHEMI';-, HFA@RT            DI-- ASEI "NISP@ lr7lED
                                                                                                             "E             -Cl.
                OROLcDUREi
          3.7. SPEC DIET: Y/NON-'- STATED                                                        34,         !V:
          35. 02/LPi@,'.@ N@                36    PT:       N          37. NS TUBE: KI           @38.        RESP, k,,                         39, FIJLEY,            N     40. STR@@KER: t4
          41.                 N             42. IRACT@      il'        43@ IMED: N               44.         CAqT/@'-00: i%' f                 45. TRACH:             iN    46. MBjN4: N
          71, PT BAB YPE:                                              72. PT BAG TAB ff:                                                      771. PT BAB      t4T:
          47, SUPP 1,N@0,        IS--,RD @IATNT             43nD SLIPY SP                                                            REPORTED BY
          44TP@, riED/471H. CSH
          48. i@iAX ENRTT- STOPS. Y / 9                                49. MAX 4@ R@nN@, Y       1 9                                           n. ALT RZST/MAX hT. N 1
VA 'CODE:
          56. ADrIN/OVERSEAS!
          56. VITAL SIGiNS(TEKF/PULSE/RESP/BLOOD @RPSS): 097.0 1                                 69          /16 i26 f      59
          59, P.GB:                         60. hCT:                   61, ABB:                                         'I DATE TA EN:
          62. WBC.                          63, SI/VSI:                64.                       VERAPA,'IIC S.,R. PO OD/ELAI;A -%2o@YiSILD
          PID          BID/1-OVENSTANITON' 2GI.NGS          BID



          6                                                                                                  WIT
          ,5. HIS' RYt SIX-VESSE', C,A.V,A.C.; REQUIRES VAL AT FACILITY                                      14 ANGIOPLASTY
                , la
          CAPABILITY PT t4ILL PROBABLY REQUIRP MEDICAL BOARD PROCEEDTNroS.








          66. ATT OHYS: j'UNES, LTC                         67. PH#; 'VOO ,)OO 000'v                                    68.    @IARD#/PH#: 000             000 000 O'VOO
          69, REPCRTC'D BY.- DENTC@'                                                                                    70.    Pq#.- (100 000@
          74@ ATTENDANT NAME #li                                                                                        7@'.   STATUS:                                76.   GRADE:
          71. A@oE-                                         78. SEX,                       70A,                         79.    RELATIONSHIP TO PATIENT:
          80. BAG TY,@'@t                                   81. BAG 'LAG 4@:                                            82.    BAG '-.4T;
          83. ATTENDANT       NAME P.2:                                                                                 64.    STATUS:                                85.   GRADE;
          86, AGE:                                          87. Sc,X.,                     87A. WT:                     88.    RELA  Tlol\Zpj  P TO PAT' NIT:
                                                     I
          89. BAB TYPE-,                                    90. BAG TAG                                                 91.    BAB WT;
          92. TRANS CRIB PHONE                                   EXT:
          03. TRANS DEST PHONE                                   CXT
          94. ETA ORIG MTF(DATE/TI@IE)@ 000                                                                             95.    ETA DEBT 'i@iTF MATE/T      IN   E): 000
          97, OTHER COMMENTS:



          51. ISN #i CJOOO/360                                                                                          52. 'RON LOC,.
          57@ VALIDATED BY/@REAS FOR HIGHER PRr,-IIDENICE:                           11
          96. AIRCRAFT ITINERARY:

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Document 7 f:/Week-32/BX000482/MEDSTAT - SITREPS DEC 90 4 OF 6/patient file:0906961515157
Control Fields 17
File Room = aug96_declassified
File Cabinet = Week-32
Box ID = BX000482
Unit = ARCENT
Parent Organization = CENTCOM
Folder Title = MEDSTAT - SITREPS DEC 90 4 OF 6
Folder Seq # = 8
Subject = PATIENT FILE
Document Seq # = 7
Document Date =
Scan Date = 14-AUG-1996
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 = 06-SEP-1996