PATIENT FILE 29 OCT 90

File: 102896_aug96_decls1_0001.txt
Page: 0001
Total Pages: 46

Subject: PATIENT FILE  29 OCT 90                                         

Box ID: BX000482

Unit: ARCENT      

Parent Organization: CENTCOM     

Folder Title: MEDSTAT - SITREPS  OCT 90  3 OF 4                                                               

Folder SEQ  #:         16

Document Number:         10



                                                                         PA    T, E;\T FILE                                             10/29/90
                                                                               1 @
                                                        PERSONAL DATA - PRIVACY ACT OF 1974



                                                                                                                                  13. MODET A
      l@  NAME:                                                 18. AUTHORITY #g 01@99AOIB 2. SSAN-.                              3.  PRECEDENCE: R
      4.  STAT: Al'                5. GRADE: c@o'_;             6. A'oEi 35Y             7. SEX: m           S. t4T-.    '50      9.  READY DAT : 299
                                                                                                                                                   .E
      10. !GO:                     II. POR:                                                                                       12. SPEC CAT:
      14, R;-:AS  REG: DS          l@@. DATE LAST VISIT@                                                                          16, CLASS: 2B
      17. ACCEPT PHYS:         JMD                                             5 U.S.C. 552 (b)(6)
                                                                                                                                  19, APPT/OIURG DATE@ NO
      20. il.PP.RGV AUTH:                                                                                                         22. VALID:                    L@,K    Y7
      23. MTF BRI@             A5150 USA DISPENSARY DHAHRAN                                                                       24@ ICPG ORIC:       OED.R
      25@ INTF DESji F507t)        USA@@Ril@P NIIESBADEN GE                                                                       26. ICAO DEST:       C,DAF
      27@ NED SPEC 1: SOO          26. DIAG 1:     7242      LUMBAGO
 DIAS 2:
      31. IVIED SPEC 3:            32@ DIAS 3:
      'o?A. PROCEDL!Rc@z
                  DIET:        MI                                                    34. 'Vg
                  v
      35. 02/LPri: &I              36. SU'UT:      N         37. NO TUBE: N          38.  RESP; N                           39. -'OLEY:            N   40. STR ER: N
      41. INCUB;               N   42. T ACT@      N         43. IMED: N             44.  CAST/LOC: N                       4i. TRACH:             N   46. MON: N
                                       .R
      71. PT BAB TYPE: NB                                    72. Fri BAB TAB                                                73, PT BAB WT:
      47@ SIJPP INFO: ****DS**** E P@o             1/5 CAV FT   HOOD TX


      46. MAX ENRTE S'OPS@ Y 1 9                             47. MAX 4t RUNS: Y      / 9                                    50. ALT REST/miAX R-i: N
      @3. INPATIENT: Y             54. SPEC PROS:       VA      DRUG           ALCOHOL    '4T     NONE X                    5@@@ VA CODE:
      56. ADMIN/CVERSEAc-z:
      @s. VITAL SIGNS(TEYiP/PU'LSc@/RESP/BLOGD PRESS)T 098.0                      @@6 1   12 /,,'OO          70
      59@ F@BB-.                   60. F@CT:                 61. ABG:                             7          DATE TAKEN:
      62. NBC:                     67. SI/VSI:               64. MEDICATIONS: VALUI@',         @,G riTD      PARAFIN FORT@ 4PO




      65@ HISTORY: H/n@ CHRONIC L014ER             BACK DAIN WITH ACUTE AS'ERBA7,ION,










      66, AT T P,'Yg:
             @ .1              UNKNOWN             67@ PP,#: 000 000 0000                                66.   WARD#/PH#: 000 / 000 000 0000
      69. REPORTED BY: GUIDO A@@150                                                                      70.   PH#: 000 0000
      74. ATT @IDAINT NAME                                                                               75.   STATUS.                             76. BRAD-:
            .@E
                78. SEX:                    76A. 14T:                 79.   RELATIONSHIP TO PATIENT:
      00. BAB TYPE:                                61. BAG TAG                                           62.   BAB @'T;
      83. ATTENDANT            NAME #2:                                                                  84.   STATUS:                             65. GRADE:
      86, ABE;                                     87. SEX:                    87A. t4T:                 86.   RELATIONSHIP TO PATIENT:
      89. BAG TYPE:                                90. BAG TAB                                           91,   BAG WT:
      92. TRANS OtRI@r PHONE                            EXT:
      93. TRANS DEST PHONE                              EXT:
      94. EIA D@RIS MTF(DATE/TPiE): O@@o                                                                 95.   ET DEST M.TF(DATE/TIM@c); 000
      97. OTHER C011riENTS@



      51. jyiSN #:                                                                                       52. RON LOC:
      57. VALIDATED BY/REAS FOR HIGHER PRECEDENCE:
      96. AIRCRAF@ ITINERARY:

Document 46 f:/Week-32/BX000482/MEDSTAT - SITREPS OCT 90 3 OF 4/patient file 29 oct 90:10019616503417
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 29 OCT 90
Document Seq # = 10
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