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- Date of Birth: 236503.11
- Sex: Male
- Species: Terran
- Height: 182 cm (6'0")
- Weight: 72 kilos (159 lbs)
- Blood Type: B-
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PAST MEDICAL HISTORY
- Chronic Illnesses: Acute Asthma
- Medications: Inhaled corticosteroids
- Allergies and Reactions: Asthma
- Sexual/Reproductive History:
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PAST HOSPITALIZATIONS/SERIOUS ILLNESS
PAST SURGICAL HISTORY
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PSYCHIATRIC HISTORY
SUBSTANCE USE HISTORY
- Alcohol: Frequent use, at risk of addiction.
- Recreation Drugs: None
- Other: None
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FAMILY MEDICAL HISTORY
- Mother:
- Father:
- Siblings:
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SOCIAL HISTORY
- Marital status: Single
- Children: None
- Occupation/Assignment: Helm & Navigational Officer, USS Apollo
- Diet:
- Exercise:
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PHYSICIANS' NOTES
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COUNSELORS' NOTES
- Counselor:
- Psychological Assessment:
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