Template:Medical Record: Difference between revisions

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*'''Height:''' 178 cm (5'10")
*'''Height:''' 178 cm (5'10")
*'''Weight:''' 73 kilos (160 lbs)
*'''Weight:''' 73 kilos (160 lbs)
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===PAST MEDICAL HISTORY===
===PAST MEDICAL HISTORY===
*'''Chronic Illnesses:'''
*'''Chronic Illnesses:'''
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===PAST HOSPITALIZATIONS/SERIOUS ILLNESS===
===PAST HOSPITALIZATIONS/SERIOUS ILLNESS===
*'''SD 237005.05:'''
*'''SD 237005.05:'''
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===PSYCHIATRIC HISTORY===
===PSYCHIATRIC HISTORY===


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===FAMILY MEDICAL HISTORY===
===FAMILY MEDICAL HISTORY===
*'''Mother:'''
*'''Mother:'''
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===SOCIAL HISTORY===
===SOCIAL HISTORY===
*'''Marital status:'''
*'''Marital status:'''
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===PHYSICIANS' NOTES===
===PHYSICIANS' NOTES===
*'''Medical Officer:'''
*'''Medical Officer:'''
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===COUNSELORS' NOTES===
===COUNSELORS' NOTES===
*'''Counselor:'''
*'''Counselor:'''

Revision as of 06:13, 3 May 2014

You can use this template to create a medical record for your character:
  1. Create a new subpage for your character by adding "/Medical Record" to the end of your character's current bio page.
    The new page will have the address Last Name, First Name/Medical Record
  2. Insert {{subst:Medical Record}} into the body of the new subpage and click save.
  3. Click edit once the page is created and fill out the details as you wish.
Example: Rahman, Roshanara/Medical Record
Starfleet Medical.png

LAST NAME, FIRST NAME MIDDLE NAME

  • Patient Reference Number: 123-456-789
  • Date of Birth:
    • Age: 41
  • Sex:
  • Species:
MEDICAL RECORD
  • Height: 178 cm (5'10")
  • Weight: 73 kilos (160 lbs)
  • Blood Type:

PAST MEDICAL HISTORY

  • Chronic Illnesses:
  • Medications:
  • Allergies and Reactions:
  • Sexual/Reproductive History:

PAST HOSPITALIZATIONS/SERIOUS ILLNESS

  • SD 237005.05:
  • SD 237007.05:

PAST SURGICAL HISTORY

  • SD 237005.05:
  • SD 237007.05:

PSYCHIATRIC HISTORY

SUBSTANCE USE HISTORY

  • Alcohol:
  • Recreation Drugs:
  • Other:

FAMILY MEDICAL HISTORY

  • Mother:
  • Father:
  • Siblings:

SOCIAL HISTORY

  • Marital status:
  • Children:
  • Occupation/Assignment:
  • Diet:
  • Exercise:

PHYSICIANS' NOTES

  • Medical Officer:
  • Medical Assessment:

COUNSELORS' NOTES

  • Counselor:
  • Psychological Assessment: