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File: 102896_aug96_decls3_0002.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:'o7il2 PATIENT FILE 12/2'1/90
PERSONAL DAT - PRIVACY ACT OF 1974
,A
5 U.S.C. 552 (b)(6)
13. MODE: A
18. AUTHORITY #: O' 71. PRECEDENCE: R
1. NAME- ZIAO57 2. SSAN:
4. STAT: All 5. GRADE: E04 6. AGE: 26Y 7. SEX@. Mi 8. 'AT: 170 9. R@ADY DATE: 350
10. ISO; li. P'UR: 12. SPEC CAT:
14. REAS RES@ DS 15. DATE LAS-, VISII: 16. CLASS: 3A
17. ACCEPT PHYS: JMRO 19. APPT/SURG DATE: NO
20, APPROV AUTH: 21. CAN'U/INC@ 22. VALID: LMK Y7
23. MTF BRIG: A5150 USA DISPENSARY DHAHRAN' 24. !CAD DRIS: DEDR
2@'. M@iF DEST: A5040 2ND GEN HOSP LANDSTUHL 26. ICAO DEST: EDAR
27. NED SPEC 1: SOD 28. DIAS 1: 75566 OTHER CONSEt4ITAL ANOMALIES OF TOES
D SPEC 2: 30@ DIAG 2@
31. MED SPEC 3@ 32. DIAG 3:
32,4. PROCEDURE:
33. SPEC DIET: N/ 34. TV:
35. 82,'LPM: N 36, SUCT: KI 37. NIS TUBE: N 38. RESP- N 39, FOLEY: N 40. STRYKER:
41. IKICUB: N 42. TRACT: N 43. IMED: N 44. CAST/LDC: N 1 45. TRACH. N 46. MO,\': N
71. PT BAB TYPE: ND 72. PT BAB TAG 73. PT BAB 6'T:
47. SUPP INFO: HHC I CAV FT HOOD, TX 47TH CSH
49. MAX ENRTE STOPS; Y / 9 49. MAX # RONST Y 1 9 @@o. ALT REST/MAX HT: N 1
53. INPATIENT: Y 54. SPEC PROB@ VA DRUG ALCOHOL WT NONE X 55. VA CODE:
56@ ADMIN/OVERSEAS:
56. VITAL SIGNS(TEMP/PULSE/RESP/BLn@OD PRESS); 098.6 80 / 20 / 130 88
59. HEB, 60. HOT: 61@ ABG: I DATE TAKEN:
62. NBC: 63. SI/VSI: 64. MEDICATIONS: NONE REPORTED
65. HISTORY- RIGHT FOOT BUNION AND HAMMER TOES SINCE 1966. NEEDS CORRECTIVE SUR
GP-7RY AND REHAB.
66. ATT PP.YS: COS-10 67. PH#: 000 000 0000 68. WARD4/PH#: 000 / 000 000 0000
69. REPORTED BY-. POTTER 70. PH#: 000 OOOAI
76. GRADE:
77. AGE: 78. Sc@X: 76A. WT: 79. RELATIONSHIP TO PATIENT:
80. BAG TYPE: gi. BAG TAG 82. BAG @,'Ti
83. ATTENDANT NAME #2; 84. STATUS: 65. GRADE-
26. AgEi 87. Sr-X: 87A. WT; 89. RELATIONSHIP TO PATIENT:
89. BAB TYPE: 90. BAB TAG 91. BAB WT:
92. TRANS ORIG PHONE 4: EXTI
93. TRANS DEST PHONE #: EXTT
94. ET CRIS 'ITF(DATE/TT@IE)@ 000 95. ETA DEST MTF(DATE/T!VE): 000
.A
97. OTHER P@OMM---t4TSt
51@ !ISN #: 0000/351 52. RON LOC:
57. VALIDATED BY/REAS FOR HIGHER POECEDENCE@
96. AIRCRAFT ITINERARYI
5 USC 552 (b)(6)
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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