Nugra/Medical Record: Difference between revisions

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(Template of Medical Record Created for Nugra)
 
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===LAST NAME, FIRST NAME MIDDLE NAME===
===NUGRA===
*'''[[StarFleet Serial Number Register|Patient Reference Number:]]''' EZ - 123 - 456
*'''[[StarFleet Serial Number Register|Patient Reference Number:]]''' XS - 223 - 746
*'''Date of Birth:'''
*'''Date of Birth:''' 234601.03
**'''Age:''' {{age|2360|03|31}}
**'''Linear Age:''' {{age|2346|01|03}}
*'''Sex:'''
**'''Actual Age:''' {{age|2143|01|03}} (See Singularity Event)
*'''Species:'''
*'''Sex:''' Male
*'''Species:''' Gorn
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*'''Height:''' 178 cm (5'10")
*'''Height:''' 205.74 cm (6'9")
*'''Weight:''' 73 kilos (160 lbs)
*'''Weight:''' 146 kilos (320 lbs)
*'''Blood Type:'''
*'''Blood Type:''' QC-
*'''[[T/E Rating]]:'''
*'''[[T/E Rating]]:''' T0/E0
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===PAST MEDICAL HISTORY===
===PAST MEDICAL HISTORY===
*'''Chronic Illnesses:'''
*'''Chronic Illnesses:'''None Noted.
*'''Medications:'''
*'''Medications:''' None.
*'''Allergies and Reactions:'''
*'''Allergies and Reactions:''' Mild allergic to wheat products. Breaks out in a rash.
*'''Sexual/Reproductive History:'''
*'''Sexual/Reproductive History:''' Declined to respond.
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===SUBSTANCE USE HISTORY===
===SUBSTANCE USE HISTORY===
*'''Alcohol:'''
*'''Alcohol:''' Moderate Consumption
*'''Recreation Drugs:'''
*'''Recreation Drugs:''' None
*'''Other:'''
*'''Other:''' N/A
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===FAMILY MEDICAL HISTORY===
===FAMILY MEDICAL HISTORY===
*'''Mother:'''
*'''Mother:''' Declined to Respond
*'''Father:'''
*'''Father:''' Declined to Respond
*'''Siblings:'''
*'''Siblings:''' Declined to Respond
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===SOCIAL HISTORY===
===SOCIAL HISTORY===
*'''Marital status:'''
*'''Marital status:''' Single
*'''Children:'''
*'''Children:''' [[Iria|Iria (Adopted)]]
*'''Occupation/Assignment:'''
*'''Occupation/Assignment:''' Commanding Officer, USS Victory
*'''Diet:'''
*'''Diet:''' Carnivore
*'''Exercise:'''
*'''Exercise:''' Moderate to Intense
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Revision as of 21:14, 21 August 2014

Starfleet Medical.png

NUGRA

  • Patient Reference Number: XS - 223 - 746
  • Date of Birth: 234601.03
    • Linear Age: 55
    • Actual Age: 258 (See Singularity Event)
  • Sex: Male
  • Species: Gorn
MEDICAL RECORD
  • Height: 205.74 cm (6'9")
  • Weight: 146 kilos (320 lbs)
  • Blood Type: QC-
  • T/E Rating: T0/E0

PAST MEDICAL HISTORY

  • Chronic Illnesses:None Noted.
  • Medications: None.
  • Allergies and Reactions: Mild allergic to wheat products. Breaks out in a rash.
  • Sexual/Reproductive History: Declined to respond.

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: Moderate Consumption
  • Recreation Drugs: None
  • Other: N/A

FAMILY MEDICAL HISTORY

  • Mother: Declined to Respond
  • Father: Declined to Respond
  • Siblings: Declined to Respond

SOCIAL HISTORY

  • Marital status: Single
  • Children: Iria (Adopted)
  • Occupation/Assignment: Commanding Officer, USS Victory
  • Diet: Carnivore
  • Exercise: Moderate to Intense

PHYSICIANS' NOTES

  • Medical Officer:
  • Medical Assessment:

COUNSELORS' NOTES

  • Counselor:
  • Psychological Assessment:
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