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File: 102896_aug96_decls4_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: 11
04:00:41 PATIENT FILE
PERSONAL DATA - PRIVACY ACT OF '974
5 U.S.C. 552 (b)(6)
18. AUT 13@ YOD'M: A
1. NA@,E: HORITY #: O,-)OIAOOI 2. @@Ai%'; 3. PRECEDENCE: R
4@ STA-!: Al' 5. irRA.@,E@ E04 6. ASEI 24Y 7. SEX; mt B. WI: 60 9. READY DATE: 300
10@ ISO: 11@ POR: 1 12. SPEP, CAT,.
14. @R@'@AS REG@ DS 15. DATE LAST VISIT. 16. CLASS@ 3.q
17. ACCEPT PHYS- 19. APPTISURC DATE: klo
l@0. A"P@IOV AUTHI 21. CAiNC/INC: 22. VALID: @iLE Y3
21. @'@TF ORIG: AS!50 USA DISPENSARY DHAHRAN 24@ ICAN@ ORIG: OC@DR
45@ MTF DEST: A5040 2iND u',;% FOSP LANDSTUHL 26. ICAO DEST: EDAR
27. V,@@D 1: ri@i)N 28@ DIAO l@ 7607, CONVULSIONS
29. XjED SPEC 2: 30. DIPG 2z
31@ rED SPEC ; 'o2, DIAG 3.
32A. PROCEDURE:
3--,. SPEC DIET: N/ 34, l@)2
7
5. 02/LPiM: iN 36@ SLI'@l: N 37. NG TUBrt: N 38@ RES@: N 719. FOLEY: N 40. STRYKER: N'
41. N 42.T ACT: N 43. IMED: N 44. P@AST/I,OC: N 45. TRACHT N' 46. @@',ON: N
,R
7'.. PT BAG TYPE: NB 72@ PT BAS TAG #t 73. PT BAG WT@
47. SLIFP INFO: PT SHERIDAN I ATH
48,-PHX ENDTE STOPS; Y 1 9 49. VAX RONS: Y 1 9 @@o. ALT @@ZSTI,@AX HT: K!
INPATIENT: Y 54. SPEC PROS: VA DRUG ALCOHOL "@ti NONE X 55. VA CODE:
,6@ A.D@ilii/QVc',RSEAS,.
58. VITAL 616NS(TEr@@D/rnULSE/RP-SP/PLGCD PRESS); 096.6 70 / i6 12@@ 1 80
HOB: 60. HOT: 61. ABG: DATE
62. '.4BC: 63. SI/VST@ 64. M'--DICAT T ON 6 ;
%,'O iN E
65. H TSTORY2 PT HAS DIZZINESS AND EPISR@' OF BLACK. OUTS, NEEDS FURTHER EVALUAT
ES
ION.
T
66. AIT PP.YS: LORA,@\@TH 67. PF.#t 000 000 0000 68. !AARD /PP@4: 000 / O'@10 O'VO 0000
69@ REPORTED BY: i@',-SGT MA.RTIt@, 70. pHt: 000 C)OOO
75. STATUS: 76. GRADE;
AN
77. AS@-t 7@ SEX: 76A. VIT: 79@ RELATIONSHIP TO PATIENT:
90. SAO TYPE: gi@ BAG TAG 82. BAG '-,4T:
B-7. P7'!ENDAiNT NAii--- 84. STATUS: 65. CRAN.E:
86@ ACr-_@ 87. SEX: 67P.. @VJ'T-, 83. RELATIONSHIP TO PATIENT:
39, BAG TYFT-. 90. BAG TAB 71. BAG
92, TRANS ORIO PHONE t,; c-XT.
9 . T AS Dc T PHONE P@XT:
,R.,N @S
0 ETA CRIG MiF(n T IT!Yi;-): 000
,4@ 1 A.cl 95. EiA DEST iMTF(DATE/-'@IME): 000
97. 07,',-,'EP, P@OMMENITS;
51. MS\ z 00001300 52. RON LOC:
57@ VA'-!DATED BY/R"cAE FOR H TSHER PRF EDEk@Cc:
EC
96@ AIRCRAFT !T!N@@RA.F@Y: I
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Document 31 f:/Week-32/BX000482/MEDSTAT - SITREPS OCT 90 3 OF 4/patient file:10019616503620
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 # = 11
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