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- Date of Birth: 234203.4
- Sex: Male
- Species: Vulcan
- Height: 182 cm
- Weight: 72 kg
- Blood Type: T+
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PAST MEDICAL HISTORY
- Chronic Illnesses:
- Medications:
- Allergies and Reactions:
- Sexual/Reproductive History:
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PAST HOSPITALIZATIONS/SERIOUS ILLNESS
PAST SURGICAL HISTORY
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PSYCHIATRIC HISTORY
SUBSTANCE USE HISTORY
- Alcohol: Occasional
- 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: Science Officer, USS Blackwell
- Diet:
- Exercise:
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PHYSICIANS' NOTES
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COUNSELORS' NOTES
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