Chythar Skyfire/Medical History

< Chythar Skyfire
Revision as of 00:05, 5 May 2014 by Zephyr (talk | contribs) (Modified first section)
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SKYFIRE, CHYTHAR DANIEL

  • Patient Reference Number:198-461-762
  • Date of Birth:236207.06
    • Age: 39
  • Sex:M
  • Species:Human
MEDICAL RECORD
  • Height: 167.64 cm (5'5" in)
  • Weight: 65 kilos (143.30 lbs)
  • Blood Type: B+ (B Positive)

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: