Template:Medical Record

Revision as of 06:39, 12 October 2014 by Rich (talk | contribs)
You can use this template to create a medical record for your character:
  1. 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
  2. Insert {{subst:Medical Record}} into the body of the new subpage and click save.
  3. Click edit once the page is created and fill out the details as you wish.

Example: Rahman, Roshanara/Medical Record


Starfleet Medical.png

Medical Record

MEDICAL RECORD
  • Height: 161 cm (5'3")
  • Weight: 56 kilos (123 lbs)
  • Blood Type: K3
  • T/E Rating: E4

PAST MEDICAL HISTORY

  • Chronic Illnesses: Neurodegenerative disease of unknown origin
  • Medications: None
  • Allergies and Reactions: None
  • Sexual/Reproductive History: None

PAST HOSPITALIZATIONS/SERIOUS ILLNESS

PAST SURGICAL HISTORY

PSYCHIATRIC HISTORY

None

SUBSTANCE USE HISTORY

  • Alcohol: None
  • Recreation Drugs: None
  • Other: None

FAMILY MEDICAL HISTORY

  • Parent 1 (Mother): None
  • Parent 2 (Father): None
  • Siblings: None

SOCIAL HISTORY

  • Marital status: Single
  • Children: None
  • Occupation/Assignment: Engineer
  • Diet: Kriosian nutritional supplement
  • Exercise: Running, 3 times a week

PHYSICIANS' NOTES

  • SD 239007.12 - Medical Officer: Niccolò del Vedova, MD
  • Medical Assessment: Lt. Commander Rahman is a 33-year-old Kriosian female who presents with persistent headaches and loss of concentration. She states the symptoms began late last year and have progressively gotten worse. I have tried various conventional medications and therapy, which have not helped. She underwent a nanite neurograft to strengthen her neuronal tissue, but it appears this has had the unfortunate effect that her neuroplasticity has only been reinforced. The current plan is to continue monitoring her condition as I seek alternative therapies.

  • SD 239110.07 - Medical Officer: Niccolò del Vedova, MD
  • Addendum: Per request of Lieutenant Sean Naughton, SB118 JAG, I have reviewed Rahman's condition and concur with the conclusion that given her susceptibility to suggestion, she is unfit for duty at this time.

COUNSELORS' NOTES

  • SD 239110.04 - Counselor: Raissa Moonsong, MD
  • Counseling Assessment: Per request of Lieutenant Sean Naughton, SB118 JAG, I met with Rahman to assess her competence to stand trial. However, due to the JAG officer's interruption of my session with the lieutenant commander, I was unable to complete my assessment. I recommend that she be given a complete evaluation at StarBase 118 before her case moves forward.