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File: 102896_aug96_decls4_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: 11
04t!0;07 PATIENT PILE
PERSONAL DATA - PRIVACY AC71 OF 1974
5 U.S.C. 552 (b)(6)
13. F@@ODE:
AUTHORITY #z 2. SSAN:
NA! -K. PRECEDENCE: R
4@ STlli Ail 5. 6RA C: C 6. AFi '42Y 7. SEX: @i 8. WT- !,-@l 9. READY DATE: 300
D@ @0-
10, ISO: !I. POR: 1 12. SPEC CAT: 1
14, OEAS RES: DS 15. DATE LAST VISIT: 16. CLASS: 3A
17, ACCEPT PHYS: JM.00 19, APPT/SURS DATE: NO
20= A7'PRGV AUTni 21@ r@ANr@/TNC: 22. VAIII@.Z
23. riTF ORIG- A5150 u'SA DISPENSARY DI.PHRAN 24. ICAO ORIBI DEDR
2@@. ITT OC-ST@ F';070 USAFRMC Wlc,SBADc,Kl 'U 26. ICAG DEST: EDAF
,7. '.'.ED SO-
@tC 1; SSR 28. DIAS It 740 CLEFT PALATE, 'JMSPECIFIED
27. M@@D SPEC 2: 30@ DIAG 2:
2
MED SPEC 3: DIAS
2A@ PRf,CE'U-RE@
3--,, SPEC DIETN/ 4. 'V: i%/
35@ 02/LPri; N 136. SUCT: N. 37, NG TUD@E@ N' 38. RESP: N' 39. FOLEY: N 41,). STRYKER: N
4@.IN' D:N42@ T ACT: %I 43. li'!E'u@ %' 44. CAS-II/Lw@C; N 45, TRACH@ N 46. MON: Ni
i u'@, R
71. PT BAG TYPE: NB 72. PT EPro TAB 73@ PT BAG W-i@
47@ SIIPP L@NFO: C BTRY /320 FA l@ll AMN@ FT CA,14.PBELL, KY REPORTED BY
28 CSH
4'0@ @'@AX C@NRTE STOPS; Y / 949. MAX '@ ROi@'S: Y 1 9 50. ALT REST)TTAX H.'@ k
51 -.@iNPATIEN'T. Y54. SPEC PR@Sfo@ VA DRUB ALCOHOL @ll \!G-\E X 55. VA CODE:
56@ AD;'@l!N./OVc,RS'cASa
56@ VITAL SIGNS'TEMP/PULSE/RESP/BL'uGD PRc,SS); 098.4 064/14 / 120 78
k
57, LIGB: 60. F.CT: 61. ABGT I DATE TAKENI@
62. t@,IBCi 63. SI/VSli 64. MEDICATIONS@ KEF',EX 500 MO QID, D!VIEAIAB -!iD
65@ 1,4.ISTORY: PROBLEMS TN GETTING SUFFI'IEN"R NUTR'TIO@,' AS A. RESULT OF PAINFL". TPE
TP@ IC ASSOCIATION @IITP@ SDIUSI I IS Ka@\'c,.RAT@ BY CHRC@ikl!C GRLIAINFLLRAL --I TI-T
i . @ @
Ch'T 2@, 'LBS @' @aR PAST 2 MONTHS
66. AT P YSn 'i!Ad SUCKV@, 67. PH,@,: OCI 000 00@VO 66. WARD#/PH#@ 000 / 000 000 0000
70. PHO.: 000 0000
74@ ATTEN@@UANT NAM; #!: 7@@. STAT'U' : 76. GRADE:
77@ AGE: 78, Sc@v@ 78A, WT: 79@ RELATIONSHIP TO PAT IENTT
80, BAG TYPEI q,!. BAB TAG 82. DAG l@iT;
671. ATTENDAtv'.-" -42: 84. SI-P.T'u'S: 85, GRACE:
86. AFZE@ 87. SEX: 87A. WTi 88. RELAT To,@ IQWTD TO PATIENT:
I . -.@ll
89. GAS TYPE- go, BAG TAG 91. BAB WT:
92. TRANS ORIG PHONE #i -tXT:
9@-. TRANS DEST PHO@NE #: EXT:
94. ETA CRIS iMTF(nvlc@/TI@IE); 95. ETA DEST @ITF(DATE/'I.',,E):
91@ OTHER COMMENTS;
IMSN #-. 00001300 5@@. iON !-CC:
z;7. VALIDAIED FilREAS FOR HIGHER PRECEDENCE:
96. AIRCRAFT ITTN
..ERARY; I 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