Taurek/Medical Record

	Taurek Patient Reference Number: KM - 412 - 490 Date of Birth: 233403.15 Age: 67 Sex: Male Species: Vulcan
		MEDICAL RECORD
	Height: 170 cm (5'7") Weight: 67 kilos (147 lbs) Blood Type: U- T/E Rating: T3
	PAST MEDICAL HISTORY Chronic Illnesses: None Medications: Testosterone propionate administered via subcranial implant (22.3mg/day) Allergies and Reactions: None Sexual/Reproductive History: One previous pregnancy, 2350-51. No other details disclosed.
	PAST HOSPITALIZATIONS/SERIOUS ILLNESS 235105.13: Admitted to T'Len-Hathara University perinatal clinic after onset of labour. Discharged 12 hours following successful c-section. PAST SURGICAL HISTORY 235105.15: Caesarian section Surgeon: Dr T'Lin, MD, VCS OR Site: T'Len-Hathara University Hospital, Vulcan Op Note: C-section performed successfully. Both parent and child are healthy. 235310.01: Sexual reassignment Surgeon: Dr Ninel Petrov, MD, IPCS OR Site: Tranquillity Hospital, Luna Op Note: Surgery proceeded without incident. Patient has been given an appointment for post-operative consultation.
	PSYCHIATRIC HISTORY Open referral for crisis counselling in 2350. Details not on file. SUBSTANCE USE HISTORY Alcohol: None Recreation Drugs: None Other: None
	FAMILY MEDICAL HISTORY Parent 1 (Mother): Systemic metabolic dysfunction, managed with medication Parent 2 (Father): None Siblings: None
	SOCIAL HISTORY Marital status: Annulled Children: None Occupation/Assignment: Counsellor Diet: Vegan Exercise: Weight training, two times a week; long-distance running, once a week; team sports, irregular
	PHYSICIANS' NOTES 234701.29 - General Practitioner: Dr T'Nisha, MD, Clinic 4011, Vulcan Medical Assessment: T'Rel is thirteen years of age and assigned female. Reports experiencing cognitive symptoms consistent with gender misalignment. Has been referred to Gender Identity Clinic in Shi'Kahr. 235008.28 - General Practitioner: Dr T'Nisha, MD, Clinic 4011, Vulcan Medical Assessment: Taurek is a pre-surgical-transition transgender male, seventeen years of age, currently attending Shi'Kahr Gender Identity Clinic. Requested a pregnancy test which was positive. Due to patient's age and circumstances, offered early termination and referral to planetary legal authorities - patient refused on both counts. Have recommended immediate cessation of hormonal treatments. Patient has been referred to ante-natal services with the option of pursuing counselling if required.
	COUNSELORS' NOTES