User:Noa T'Nessa Levinson/Sandbox5: Difference between revisions
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(Undo revision 327553 by Noa T'Nessa Levinson (talk)) Tag: Undo |
(Copying from Template:Medical Record LCARS for modification) |
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{| | <includeonly>{|style="max-width:700px" | ||
|style="background: | |style="background:teal;" width="100"| | ||
{| style=" | |width="600" colspan=2|[[File:Starfleet Medical.png|right|150px|link=Category:Medical Records]] | ||
| | ===<span style="text-transform:uppercase;">{{BASEPAGENAME}}</span>=== | ||
| | *'''[[StarFleet Serial Number Register|Patient Reference Number:]]''' {{{SERIAL NUMBER|}}} | ||
| | *'''Date of Birth:''' {{{BIRTHYEAR|}}}{{{BIRTHMONTH|}}}.{{{BIRTHDATE|}}} | ||
| | **'''Age:''' {{age|{{{BIRTHYEAR|}}}|{{{BIRTHMONTH|}}}|{{{BIRTHDATE|}}}}} | ||
| | *'''Sex:''' {{{SEX|}}} | ||
|} | *'''Species:''' {{{SPECIES|}}} | ||
|- | |||
|style="background:teal; border-radius: 0 0 0 14px; border:0px solid #AFA3BF"| | |||
|style="background:teal" | | |||
!width=180 align=right style="line-height: 130%;"|<font size="4" color=teal>MEDICAL RECORD</font> | |||
|- | |||
|style="background:teal; border-radius: 14px 0 0 0; border:0px solid #AFA3BF"| | |||
|colspan=2| | |||
*'''Height:''' {{{HEIGHT|}}} | |||
*'''Weight:''' {{{WEIGHT|}}} | |||
*'''Blood Type:''' {{{BLOOD TYPE|}}} | |||
*'''[[T/E Rating]]:''' {{{T/E RATING|}}} | |||
|- | |||
|style="background:teal;"| | |||
|colspan=2| | |||
===PAST MEDICAL HISTORY=== | |||
*'''Chronic Illnesses:''' {{{CHRONIC ILLNESSES|}}} | |||
*'''Medications:''' {{{MEDICATIONS|}}} | |||
*'''Allergies and Reactions:''' {{{ALLERGIES & REACTIONS|}}} | |||
*'''Sexual/Reproductive History:''' {{{SEXUAL/REPRODUCTIVE HISTORY|}}} | |||
|- | |||
|style="background:teal;"| | |||
|colspan=2| | |||
===PAST HOSPITALIZATIONS/SERIOUS ILLNESS=== | |||
{{{PAST HOSPITALIZATIONS/SERIOUS ILLNESS|}}} | |||
===PAST SURGICAL HISTORY=== | |||
{{{PAST SURGICAL HISTORY|}}} | |||
|- | |||
|style="background:teal;"| | |||
|colspan=2| | |||
===PSYCHIATRIC HISTORY=== | |||
{{{PSYCHIATRIC HISTORY|}}} | |||
===SUBSTANCE USE HISTORY=== | |||
*'''Alcohol:''' {{{ALCOHOL USE|}}} | |||
*'''Recreation Drugs:''' {{{RECREATIONAL DRUG USE|}}} | |||
*'''Other:''' {{{OTHER SUBSTANCE USE|}}} | |||
|- | |||
|style="background:teal;"| | |||
|colspan=2| | |||
===FAMILY MEDICAL HISTORY=== | |||
*'''Mother:''' {{{MOTHER MEDICAL HISTORY|}}} | |||
*'''Father:''' {{{FATHER MEDICAL HISTORY|}}} | |||
*'''Siblings:''' {{{SIBLING MEDICAL HISTORY|}}} | |||
|- | |||
|style="background:teal;"| | |||
|colspan=2| | |||
===SOCIAL HISTORY=== | |||
*'''Marital status:''' {{{MARITAL STATUS & SPOUSE|}}} | |||
*'''Children:''' {{{CHILDREN|}}} | |||
*'''Occupation/Assignment:''' {{{OCCUPATION|}}} | |||
*'''Diet:''' {{{DIET|}}} | |||
*'''Exercise:''' {{{EXERCISE|}}} | |||
|- | |||
|style="background:teal;" colspan=3 height=4| | |||
|- | |||
|style="background:teal;"| | |||
|colspan=2| | |||
===PHYSICIANS' NOTES=== | |||
{{{PHYSICIANS NOTE|}}} | |||
|- | |- | ||
|style="background:teal;" colspan=3 height=4| | |||
|- | |- | ||
|style="background: | |style="background:teal;"| | ||
|colspan=2| | |||
===COUNSELORS' NOTES=== | |||
{{{COUNSELORS NOTE|}}} | |||
|} | |} | ||
__NOEDITSECTION__ | |||
__NOTOC__ | |||
</includeonly> | |||
<noinclude>[[Category:Adingo]]</noinclude> | <noinclude>[[Category:Adingo]]</noinclude> | ||