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File: 102896_aug96_decls1_0002.txt
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
06:46:"I PAIIENT FILE iO/29/90
Pc@RSON',ql- DATA - PRIVA@uy AC[ OF 1974
13. MODE. A
is. AUTHORITY *: 029BA013 2, SSAN: PRECEDENCE: R
4. ST 't Al' 5. G'nAD@ci E03 6. ASET 19Y 7. SEX: F S. WT: 115 9. READY DATE; 'L96
@AiI
'O. !so: 11@ POR@ 12. SPEC CAT:
14, T@EAS REG: DS 15. DATE LAST VISIT: 16. CLASS: 2B
17@ ACCEPT PF@YS: JIMRO 5 U.S.C. 552 (b)(6) 19. APP-,@ISURG DATE: NO
20. APPROV AUTH@ 21. @,AN!'u/iN'C: 22. VALID: LMK YI
23@ @MiF CDIG: A5150 LISA DISPENSARY DHAHRAN 24. ICAG OPIC: OEDR
25. @,TF Dc@ST,. A5030 FRANKFURT ARMY REG MED 26. ICAO DEST@ EDAF
27. 41ED SPEC 1: SOD 28@ DIAG l@ 71886 OTHER JOINT DERANGEMENT, j%'E@, INVOLVING LOWER '@EG
29. "@ED SPEC 'L: 30. DTAG 2:
31. rED SPEC 7@: 32. DIAS 3:
32A. PROCEDURE:
1
35. 02/LPN: N Sul'uT: N 37. NIB TUBE: N RESP: IN 39. FOLEY: N 40. STRYKER: ti
41. I,,NCUB: iN 42. TRACT: N 4-6. 'NED: )N 44. CAST/LOC; N 1 45. TRACH: N 46. MON: iN
71. Pi BAG TYPE, ND 72. Fi BAG TAG 73. PT BAG V-T:
47@ SUPP INFO@ 47TH 0,ED BDa FORT SILL, G@ REPORTED BY
SUB AREA - 47tH FLD FIGSP
41 MAX C@NRTE STOPS: Y 9 49, MAX Y / 9 5'v. ALT REST/@MAX HT: N
53- Lt@IPF,!EN'T: Y 54@ SPEC PROD: VA DRUG ALCOHOL WT NONE X 55. VA CODE!
56@ AD,,MIN/OVc@RSEAS:
58, VITAL SIGNE(TEViP/PULSE/RESP/BLGBD PRESS): 097.6 / 70 1 18 / lllo 78
59. HOB, 60. F@CTT 61. ABS: I DATE TAKEN:
6'-?. WB@@: 63. SIIVSI. 64. MEDICATIONS; @iGiNE REPORTED
65. HISTORY- PT FELL DOWN STAIRS APX ONE YEAR AGO. CHRONIC PROBLEMS SINCE.
RECOMMEND SURGERY AND POSSIBLE MEDICAL BOARD.
66@ AT-; PHYS: LTC YAN'A@ITO 67. F,4#: 000 000 0000 68. WARD#/PH#: 000 / 000 000 0000
,49, REPORTED BY: GUIDO 70. PH#@ 000 0000
74@ ATTENDANT NAME #I-. 75. STATUS: 76, GRADE:
RELATIONSHIP TO PATIEN);
60. BAG TYPE: Bl@ BAS TAG 4: 82, BAG NT:
87
ATTENDANT NAME 42: 84, STATUS: 85. 6,RADE@
96. AGE- 87. SEX: 87A. t4T: 88. RELATIONSHIP TO DA,'@ENT:
89. BAG TYPE: 90, BAG TAG 41: 91. BAG @!T:
92. TRANS CRIB PHONE Oz EXT:
g-,. TA@,N@'S D' T PHONE EXT:
R as
EtA ORIG MTP(DAT--'ITIiME)@ 000 95, ETA DEST VITF(DAT ITIVE)I 000
E
97. OTHER 'UoritIENTS-
51@ il!SN #i 4549/298 52. RON LOC@
57@ VALIDATED BY/REAS FOR HIGHER PDECEDc,t\'CE-.
96, AIRCRAFT ITINERARY: f
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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