Varu Novin/Medical Record

	VARU, NOVIN Patient Reference Number: DE - 959 - 746 Date of Birth: 236404.08 Age: 37 Sex: Male Species: Bajoran/Trill-Hybrid
		MEDICAL RECORD
	Height: 180 cm (5'11") Weight: 75 kilos (165 lbs) Blood Type: T/E Rating: T0/E0
	PAST MEDICAL HISTORY Chronic Illnesses: Medications: Allergies and Reactions: Sexual/Reproductive History:
	PAST HOSPITALIZATIONS/SERIOUS ILLNESS None PAST SURGICAL HISTORY None
	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: