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File: 102896_aug96_decls2_0003.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 029OA029 2. SSAN: @ 3. PRECEDENCE,. R
4. STAT: All 5. GRADE: E04 6. AGE: 20Y 7. SEX: F S. WT: 130 9. READY DATE: 290
10. ISO: 11. POR: 12. SPEC CAT: 1
14. REAS REG. DS 15. DATE LAST VISIT: 16. CLASS: 3A
17. ACCEPT PHYS- JMRO 19. APPT/SURS DATE: NO
20. APPROV AUTH: 21. CANCIINC- 22. VALID: SMF Y7
23. MTF DRIS: A5150 USA DISPENSARY DHAHRAN 24. ICAG GRIG: GEDR
25. MTF DEST: A5030 FRANKFURT ARMY REG MED 26. ICAO DESTI EDAF
27. MED SPEC 1: SGD 28. DIAS I-. V220 SUPERVISION OF NORMAL FIRST PREGNANCY
29. VED SPEC 2: 30. DIAG 2:
31. MED SPEC 3: 32. DIAG 3.
32A. PROCEDURE:
. SPEC DIET: N/ 34. IV:
35. 02/LPM. N 36. SUCT: N 37. NS TUBE: N 38. RE6P. N 39. FOLEY; N 40. STRYKER: N
: N 44. CAST/LOC: N 1 45. TRACH. N 46. MDN: N
71. PT BAG TYPE: NB 72. PT BAG TAG 73. PT BAG WT-
47. SUPP INFO: 24TH ID, FT@ STERWART, GA
49@ MAX ENRTE STOPS. Y 9 49. MAX # RONS-. Y / 9 50. ALT REST/MAX NT: N
53. INPATIENT: Y 54. SPEC PROB: VA DRUG ALCOHOL WT NONE X 55. VA CODE:
56. ADMINIOVERSEAS.,
58. VITAL SIGNS(TEKP/PULSE/RESP/BLGOD PRESS): 098.2 80 / 16 / 98 70
59. HGB- 60. HCT: 61. ADO: DATE TAKEN:
62. WBC: 67@. SIIVSI: 64. MEDICATIONS: N
65. H16TORY: PT HAS FOSITIVE PREG TEST. ULTRASOUND REVEALS CYST. 5 WK GESTATIO
i\'AL SAC.
66, ATT PHYS: BAKER 67. PH4: 000 000 0000 68. WARD#/PH#: 000 I 000 000 0000
69. REPORTED BY- SST MARSHAN 70. PH#- 000 0000
74@ ATTENDANT NAME #I; 75. STATUS@. 76. BRADE-
77. AGE: 78. SEX: 78A. WT,. 79. RELATIONSHIP TO PATIENT:
80. BAB TYPE. 61. BAB TAG 02. BAG WT:
83. ATTENDANT NAME #2. 84. STATUS: 85. GRADE-
86. AGE. 87. SEX: 87A. WT: 86. RELATIONSHIP TO PATIENT:
89. BAG TYPE-. 90. BAG TAG 91. BAG WT:
'rL. TRANS DRIS PHONE EXT-
EXT:
94. ETA ORIG MTF(DATE/TIME): 000 95. ETA DEST MTF(DATE/TIME): 000
97. OTHER COMMENTS:
51, MSN #: 52. RON LOC:
57. VALIDATED BY/REAS FOR HIGHER PRECEDENCE-
96. AIRCRAFT ITINERARY:
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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