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File: 102896_aug96_decls1_0003.txt
Page: 0003
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



                  06:46:'4L                                         **** PATIENT FILE ****                                                  iO/2@/90
                                                           PERSONAL DATA - PRIVACY Ap.T Or- '?74



                                                                                                                                            ',ODE; A
                  NIA@',,E;                                      18. AUTHORITY #.- 029SA05' 2. SSANT                                    3.  @RECEDEN@CE@ R
      4.          STAT! All         5. CO DE: 006                 6. A'        50Y       7@ SEX: M              8. 'OT:      19B        9.  READY DATE: 293
                                         @,A                             GE
      10.         730,.             11. POR@                                                                                            12. SPEC CAI:
      14.         REAS RES; DS      15. DATE LAST VISIT:                                                                                16. 'CLASS: 3A
      17.         ACCEPT PHYS:                                      5    U.S.C. 552 (b)(6)                                              19. APPIISURG DATE: NO
      20.         APP@ROV ALIT@.!                                                       21.                                             22, VALID:           I       L@MK     Y4
      2'.         MTF 0,Rl@  A5150  USA DISPENSARY DHAHRAN                                                                              24. ICAO CRIG:       DEDR
      25.         i@TF DEST; F5070  USAFRIMC WIESBADEN Gc                                                                               26. ICAO DEST:       EDAF
      27.         V@ED SPEC  1: FIMA 28@ DIA' l@ 4619         ACLIT' SINUSI'TS, UNI;PE@',FTED
      '-)g@       riED SPEC  2: SBR 30. DIAS   'L; 4739       CHRONIC SIN@JBITIS, UNSPECIFIED
      31.         IM'@D SPEC 7@:    @@2@ DIAS  70:
      32A. @DoCc,DU@RF-:
                                                    34. IV:
      75@         32/LPM: N         36. SUCTZ      N          37@ Ng TUBE: Ni           '@s.  RESP: N                            39. FOLEY@            N     40, STRYKER: N
      41@         !NCUQ:     N      42. TRACT; N              43. II@ED@ N              44.   CAST/LOC: N                        4@@. iRA,@@H@         N     46. MOIN: N
      71.         PT BAB TYPE: @NB                            72. PT BAG iAS                                                     73. PT BAG WT:
      47@         SUPP INFO: OTSO, FALLS CHURCH, VA                                                                    REPORTED BY
      56T,@i ATH.
      49.         @iAX ENRTE STOPS. Y / 9                     49@ IIAX # ROIIS: Y           9                                    50@ ALT REST/iiAX HT: N
                  TN@OA'IENT@ Y     54. SPEC PROGT         VA       DOUG       ALCOHOL        WT       NIONE X                   55, VA CODE:
      @3          ,I
      56.         ADVi!N/OVc,RSEASi
                  (A-
      @8.         Vi@ i SIGNS(TEr,-P/PULSE/RESP/BLOOD PRESS): 098.0                   72      16       130 1      96
      59.         PGB:              60. HCT:                  61@ ABG:                                        / DATE TAKEN:
      62.         i4BC@             63. SI/VS!:               64. MEDICATIONS: HUMIBID I TAB BID, BECONASE NASAL 9
      PRAY TIE, nly@',ITAP I TAB DID 2 [ABS 0 4F.Rg. AFRIN NASAL SPRAY TRS.


      65. HISTORY: HX CiF CHRONIC ACUTE SINUSTTIS FOR SEVERAL YEARS. SY@'jPTOM.6 PERSIST
      DESPITE SEVERAL COURSES 07 Ar4TIODIDTIn THERAPY A D FOUR SURBICAL PROCEDURES I
      N @OASI.







      66@         ATT PHYS: RODBERS               67. PH4: 000 000 000(i                                      68@   'AARD#/PH@          000 / 000 000 0000
      69.         REPORTED BY: '@AREPANIT                                                                     70.   PH'@! 000 0000
                                              75.   STATUS:                              76. GRADE:
                  AT
      77,         AGE:                            76. Sq@                       78A. WT!                      79.   RELATIONSHIP TO PATIENT:
      80.         BAG TYPE:                       81. BAG TAG #i                                              82.   BAG WT:
      83.         ATTENDANT  NIAVIE #2.                                                                       84.   STATUS:                              85, GRADE:
      86.         AGE:                             87, SEX;                     67A. WT:                      88.   RELATIONSHIP TO PATIENT:
      89.         BAB TYPE:                        90. BAB TAG                                                91.   BAG t4T:
      92.         TRANS gRiG PHONE t@                      EXI:
      9Z%.        TRANS DEST PHONE #:                      EXTI
      94.         ETA ORIG riF(DA P/T'ME): 000 1                                                              95.   ETA DEST MTF(DATc/TIME): 000
      97@         OTHER



      51.         vSN 4@: 0000/298                                                                            52. RON LOC:
      57@         VALIDATED BY/REAS FOR HIGHER PRECEDENCE:
      96.         AIRCRAFT ITTNFRARY:           I
                             I

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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