Chythar Skyfire/Medical History: Difference between revisions

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(saved page with template:Medical_Record on it, will be making subsequent changes.)
(should've read the part where it said {{subst:Medical_Record}}. Done.)
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{{Template:Medical_Record}}
 
{|style="max-width:700px"
|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===
*'''Patient Reference Number:''' 123-456-789
*'''Date of Birth:'''
**'''Age:''' {{age|2360|03|31}}
*'''Sex:'''
*'''Species:'''
|-
|style="background:teal; border-radius: 0 0 0 14px; border:0px solid #AFA3BF"|
|style="background:teal" |
!width=200|<font size="4" color=teal>MEDICAL RECORD</font>
|-
|style="background:teal; border-radius: 14px 0 0 0; border:0px solid #AFA3BF"|
|colspan=2|
*'''Height:''' 178 cm (5'10")
*'''Weight:''' 73 kilos (160 lbs)
*'''Blood Type:'''
|-
|style="background:teal;"|
|colspan=2|
===PAST MEDICAL HISTORY===
*'''Chronic Illnesses:'''
*'''Medications:'''
*'''Allergies and Reactions:'''
*'''Sexual/Reproductive History:'''
|-
|style="background:teal;"|
|colspan=2|
===PAST HOSPITALIZATIONS/SERIOUS ILLNESS===
*'''SD 237005.05:'''
*'''SD 237007.05:'''
 
===PAST SURGICAL HISTORY===
*'''SD 237005.05:'''
*'''SD 237007.05:'''
|-
|style="background:teal;"|
|colspan=2|
===PSYCHIATRIC HISTORY===
 
===SUBSTANCE USE HISTORY===
*'''Alcohol:'''
*'''Recreation Drugs:'''
*'''Other:'''
|-
|style="background:teal;"|
|colspan=2|
===FAMILY MEDICAL HISTORY===
*'''Mother:'''
*'''Father:'''
*'''Siblings:'''
|-
|style="background:teal;"|
|colspan=2|
===SOCIAL HISTORY===
*'''Marital status:'''
*'''Children:'''
*'''Occupation/Assignment:'''
*'''Diet:'''
*'''Exercise:'''
|-
|style="background:teal;" colspan=3 height=4|
|-
|style="background:teal;"|
|colspan=2|
===PHYSICIANS' NOTES===
*'''Medical Officer:'''
*'''Medical Assessment:'''
|-
|style="background:teal;"|
|colspan=2|
===COUNSELORS' NOTES===
*'''Counselor:'''
*'''Psychological Assessment:'''
|}
__NOTOC__
[[Category:Medical Records]]

Revision as of 23:52, 4 May 2014

Starfleet Medical.png

LAST NAME, FIRST NAME MIDDLE NAME

  • Patient Reference Number: 123-456-789
  • Date of Birth:
    • Age: 41
  • Sex:
  • Species:
MEDICAL RECORD
  • Height: 178 cm (5'10")
  • Weight: 73 kilos (160 lbs)
  • 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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