View source for Danielle Vistain/Medical Record


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===VISTAIN, DANIELLE===
*'''[[StarFleet Serial Number Register|Patient Reference Number:]]''' EZ - 123 - 456
*'''Date of Birth:''' 236503.13
**'''Age:''' {{age|2365|03|13}}
*'''Sex:''' Female
*'''Species:''' [[Human]]
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!width=180 align=right|<font size="4" color=teal>MEDICAL RECORD</font>
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*'''Height:''' 165 cm (5'5")
*'''Weight:''' 61 kilos (134 lbs)
*'''Blood Type:'''
*'''[[T/E Rating]]:'''
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===PAST MEDICAL HISTORY===
*'''Chronic Illnesses:'''
*'''Medications:'''
*'''Allergies and Reactions:'''
*'''Sexual/Reproductive History:'''
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===PAST HOSPITALIZATIONS/SERIOUS ILLNESS===
*'''SD 237005.05:'''
*'''SD 237007.05:'''

===PAST SURGICAL HISTORY===
*'''SD 237005.05:'''
*'''SD 237007.05:'''
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===PSYCHIATRIC HISTORY===

===SUBSTANCE USE HISTORY===
*'''Alcohol:'''
*'''Recreation Drugs:'''
*'''Other:'''
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===FAMILY MEDICAL HISTORY===
*'''Mother:'''
*'''Father:'''
*'''Siblings:'''
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===SOCIAL HISTORY===
*'''Marital status:'''
*'''Children:'''
*'''Occupation/Assignment:'''
*'''Diet:'''
*'''Exercise:'''
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===PHYSICIANS' NOTES===
*'''Medical Officer:'''
*'''Medical Assessment:'''
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===COUNSELORS' NOTES===
*'''Counselor:'''
*'''Psychological Assessment:'''
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__NOTOC__
[[Category:Medical Records]]