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File: 102896_aug96_decls2_0002.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: 6
04:40 PATIENT FILE 10/22/90
PERSONAL DATA - PRIVACY ACT OF 1974
5 U.S.C. 552 (b)(6)
13. MODE: A
1. NAME: 18. AUTHORITY #: 029OA028 2. SSAN: 3. PRECEDENCE: R
4, STAT: All 5. 6RADE-. E02 6. AGE: 20Y 7. SEX, F S. WT: 140 9. READY DATE@ 290
10. Isag 11. PGR: 1 12. SPEC CAT:
14. REAS REG: DS 15. DATE LAST VISIT. 16. CLASS- 3A
17. ACCEPT PHYS.- JMRO 19. APPT/SURB DATE: NO
20. APPROV AUTH.- 21. CANCIINC- ??. VALID- I SMF Y7
23. MTF DRIG.- A5150 USA DISPENSARY DHAHRAN 24. ICAD CRIG. GEDR
25. MTF DEST: A5040 2ND GEN HOSP LANDSTUHL 26. ICAD DESTT EDAR
27. MED SPEC 1. MMC 2B. DIAG I- 42781 SINGATRIA'@ NODE DYSFUNCTION
29. MED SPEC 2, 30. DIAS 2:
31. NED SPEC 3: 32. DIAG 3i
32A. PROCEDURE-
33, SPEC DIET: Y/NON STATED 34. IV:
35. 02/LPM: N 1 36. SUCT. N 37. NG TUBE: N 36. RESP- N 39. FOLEY: N 40. STRYKER: N
41. INCUB: N 42. TRACT: N 43@ IMED: N 44. CAST/LDC: N 45. TRACH: N 46. MONI N
AG TYPE. NB 72. PT BAG TAG r@ PT BAG WT:
47. SUPP INFO: F CO 724TH SUPPORT BN, 24TH INF DIV, FT. STEWART, GA
48. MAX ENRTE STOPS: Y / 9 49. MAX # RONS: Y 1 9 50. ALT REST/MAX HT: N
53. INPATIENT: Y 54. SPEC PROG: VA DRUB ALCOHOL WT NONE X 55. VA CODE:
56. ADIIN/DVERSEAS,
58. VITAL SIGNS(TEt'@P/PULSE/RESP/BLOOD PRESS)- 098.2 35 / 14 / 110 70
59. HGB: 60. HCT-. 61. ADS. I DATE TAKEN-
62. WBC: 63. SI/Vgl: 64. MEDICATIONS: N
65, HISTORY: PT HAD BRIE 5 SECOND NEAR SYNCOPY 15 Ou'T 90. EKG MARKED SINUS, BAR
UA.RDIA SINUS A@RRYTHMIA, I WAVE INVERSION, WI TO V3, PROBABLY NORMAL YOUTH PAT
TERN. HALTER EGG REQUESTED.
66. VIT PHYS- HAASWESTON 67. PH#: 000 000 0000 69. WARD#/PH#: 000 I 000 000 0000
69. REPORTED BY- LCDR GUIDO 71L PH#: 000 0000
74. ATTENDANT NAME #I: 75. STATUS: 76. GRADE:
77. AGE: 78. SEX: 78A. WT: 79. RELATIONSHIP TO PATIENT-.
60. BAG TYPE: 81, BAG TAG 82. BAG WT.
83. ATTENDANT NAME #2z 84. STATUS: 85. GRADE:
86. AGE@ 87. SEX: 87A. WT: 66. RELATIONSHIP TO PATIENT:
89. BAG TYPE: 90. BAG TAG 91. BAG WT:
92. TRANS CRIG PHONE EXT:
EXT:
94@ ETA ORIS MTF(DATE/TIME): 000 95. ETA DEST MTF(DATE/TIME): 000
97. OTHER COMMENTS:
51. IMSN #: 52. RON LOC-
57. VALIDATED BY/REAS FOR HIGHER PRECEDENCE:
96. AIRCRAFT ITINERARY4 I f
I
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Document 41 f:/Week-32/BX000482/MEDSTAT - SITREPS OCT 90 3 OF 4/patient file:10019616503518
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 # = 6
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