Template:Medical Record: Difference between revisions

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|colspan=2|[[File:Starfleet Medical.png|right|150px|link=]]
|colspan=2|[[File:Starfleet Medical.png|right|150px|link=]]
===LAST NAME, FIRST NAME MIDDLE NAME===
===LAST NAME, FIRST NAME MIDDLE NAME===
*'''Patient ID Number:'''
*'''Patient Reference Number:'''
*'''Date of Birth:'''
*'''Date of Birth:'''
**'''Age:''' {{age|2360|03|31}}
**'''Age:''' {{age|2360|03|31}}

Revision as of 07:15, 29 April 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:
  • Date of Birth:
    • Age: 41
  • Sex:
  • Species:
MEDICAL RECORD
  • Height:
  • Weight:
  • 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:
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