Danielle Vistain/Medical Record: Difference between revisions

Latest revision as of 00:58, 14 October 2015

	VISTAIN, DANIELLE Patient Reference Number: EZ - 123 - 456 Date of Birth: 236503.13 Age: 36 Sex: Female Species: Human
		MEDICAL RECORD
	Height: 165 cm (5'5") Weight: 61 kilos (134 lbs) Blood Type: T/E Rating:
	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:

@@ Line 3: / Line 3: @@
 |style="background:teal;" width="100"|
 |width="600" colspan=2|[[File:Starfleet Medical.png|right|150px|link=Category:Medical Records]]
-===LAST NAME, FIRST NAME MIDDLE NAME===
+===VISTAIN, DANIELLE===
 *'''[[StarFleet Serial Number Register|Patient Reference Number:]]''' EZ - 123 - 456
-*'''Date of Birth:'''
+*'''Date of Birth:''' 236503.13
-**'''Age:''' {{age|2360|03|31}}
+**'''Age:''' {{age|2365|03|13}}
-*'''Sex:'''
+*'''Sex:''' Female
-*'''Species:'''
+*'''Species:''' [[Human]]
 |-
 |style="background:teal; border-radius: 0 0 0 14px; border:0px solid #AFA3BF"|
@@ Line 16: / Line 16: @@
 |style="background:teal; border-radius: 14px 0 0 0; border:0px solid #AFA3BF"|
 |colspan=2|
-*'''Height:''' 178 cm (5'10")
+*'''Height:''' 165 cm (5'5")
-*'''Weight:''' 73 kilos (160 lbs)
+*'''Weight:''' 61 kilos (134 lbs)
 *'''Blood Type:'''
 *'''[[T/E Rating]]:'''