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 The patient reference number is from the StarFleet Serial Number Register and is also used as the student ID in the academic transcript template from Starfleet Academy.

	LAST NAME, FIRST NAME MIDDLE NAME Patient Reference Number: EZ - 123 - 456 Date of Birth: Age: 41 Sex: Species:
		MEDICAL RECORD
	Height: 178 cm (5'10") Weight: 73 kilos (160 lbs) Blood Type: T/E Rating:
	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: