Template:Medical Record

You can use this template to create a medical record for your character: 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 Insert {{subst:Medical Record}} into the body of the new subpage and click save. Click edit once the page is created and fill out the details as you wish. Example: Rahman, Roshanara/Medical Record

	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: