Template:Medical Record: Difference between revisions
Jump to navigation
Jump to search
No edit summary |
No edit summary |
||
Line 6: | Line 6: | ||
}} | }} | ||
<onlyinclude> | <onlyinclude> | ||
{| | {|style="max-width:700px" | ||
|style="background:teal;" width="100"| | |style="background:teal;" width="100"| | ||
|colspan=2|[[File:Starfleet Medical.png|right|150px|link=Category:Medical Records]] | |width="600" colspan=2|[[File:Starfleet Medical.png|right|150px|link=Category:Medical Records]] | ||
===LAST NAME, FIRST NAME MIDDLE NAME=== | ===LAST NAME, FIRST NAME MIDDLE NAME=== | ||
*'''Patient Reference Number:''' 123-456-789 | *'''Patient Reference Number:''' 123-456-789 |
Revision as of 06:18, 3 May 2014
You can use this template to create a medical record for your character:
|
LAST NAME, FIRST NAME MIDDLE NAME
| ||
MEDICAL RECORD | ||
---|---|---|
| ||
PAST MEDICAL HISTORY
| ||
PAST HOSPITALIZATIONS/SERIOUS ILLNESS
PAST SURGICAL HISTORY
| ||
PSYCHIATRIC HISTORYSUBSTANCE USE HISTORY
| ||
FAMILY MEDICAL HISTORY
| ||
SOCIAL HISTORY
| ||
PHYSICIANS' NOTES
| ||
COUNSELORS' NOTES
|