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File: 102896_aug96_decls3_0001.txt
Subject: PATIENT FILES 21 DEC 90
Box ID: BX000482
Unit: ARCENT
Parent Organization: CENTCOM
Folder Title: MEDSTAT - SITREPS DEC 90 2 OF 6
Folder SEQ #: 6
Document Number: 5
04:36:5 7 'AT--' T FILE 12/21/@O
PERSONA" DATA - PRIVACY ACT OF '974
5 U.S.C. 552 (b)(6)
13. i@j@DE: A
I m 18. AUTHORITY #: 035IAO52 2. SSANI: 3@ PRECEDFK'CE: R
4. SIAT: .411 5. GRADE: E@@6 6. AGE: 30Y 7. SFXI t, S. WT. 195 9. READY DATE: 350
10. ISO- 1-1. POR: 12. SPEC CAT:
14. REAS REG: DS 15. DATE LAST VISIT: 16. CLASS: 3A
17. ACCT-PT PHYS: JRRO 19. APPT/SURG DATE: NO
20@ APPROV AUTH@ 21. CANC/INC: 22. VALID: LMv Y7
23. MiF BRIG@ A5150 USA DISPENSPRY DHAHRAN 24. ICAD ORIG: GEDR
25. i@iTF DEST@ F5070 USAFRIMC WIESBADEN 6c 26. ICAO DEST- EDAF
27. NED SPEC 1: SSE 28. DIAG 1: 73342 ASEPTIC NECROSIS OF HEAD AND NECK OF FEMUR
29. M.ED O@PEC .': 30. DIAS 2:
31. VIED SPEC 3: 32. DIAG 3;
32A. PROCEDURE:
33. SPEC DIET@ NI 34. IV:
TRYKER: N
41. INCUB: N 42. TRACT: N 43. !V@ED; N 44. @'AST/LOP@: @kl 45. TRA@UH: N 46. ,MDI: N
71. PT BAB IYPE: NB 72. Pi BAG TAG 7@'. PT BAB @Tt
47. SUPP INFO: 1/67 ARM 2 AR@MD DIV FT. HOOD, TX 47TH CSH
48. MAX ENIRTE STOPS: Y 9 49. MAX # RONS: Y / 9 30. ALT REST/MAv HT: N
53. INPATIENT: Y 54. SPEC PROG: VA DRUB ALCOHOL .14T NONE X 55@ VA CODE:
,6. ADi4IN/OVERSEAS:
58. VITAL SIGNS@TE@1P/PULSE/RESP/BLOOD PRESS): 099.2 88 / 20 / I'@O / 86
59. HOD: 60. HOT: 61, ABB: J DATE TAKEN@
62. WBC: 63. SI/VSI@ 64. MEDICA[IONS: moTRiN 800 MG TID
65. HISTORY: VASCULAR NECRUSIS, STASE 3 TO RISHT AND STAGE 2 TO LEFT. NEEDS
SURGERY OR EVALUATION FOR IMEB,
66. ATT PHYS: COSIO 67. PH#: 000 000 0000 66. WARD#/PH#: 000 / 000 000 0000
69. REPORTED BY: POTTER 70, PH.#: 000 0000
74. ATTEI\'DANT NAME #I: 75. STATUS: 76. GRAD'M:
77'AGE: 76. SEX: 78A. WT-, 79. RELATIONSHIP TO PATIENT:
80@ DAB TYPE: 81. BAB TAG 32. BAB WT:
83. ATTENDANT NAME @2,. 84. STATUS. 65. GRADE:
87A. WT: 88, RELATIONSHIP TO PATIENT;
89. BAB TYPET 90. BAG TAG 91. BAG WT:
92. TRANS CRIS PHONE EXT:
93, TRANS DEST PHONE EXT@
94. ETA CRIG MTF(DATE/TI,@,E)- 000 95. ETA DEST MTF(DATE/TIME): 000
97@ OTHER COMMENTS:
51. MEN #: 00001 1 52. RON LOC:
57. VA]-!DATED BYYREAS FOP HIGFED PRECEDENCE: 1
96. AIRCRAFT ITINERARY; I I
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Document 26 f:/Week-32/BX000482/MEDSTAT - SITREPS DEC 90 2 OF 6/patient files 21 dec 90:10019616503519
Control Fields 17
File Room = aug96_declassified
File Cabinet = Week-32
Box ID = BX000482
Unit = ARCENT
Parent Organization = CENTCOM
Folder Title = MEDSTAT - SITREPS DEC 90 2 OF 6
Folder Seq # = 6
Subject = PATIENT FILES 21 DEC 90
Document Seq # = 5
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