Difference between revisions of "Shedet/Medical Records"

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(Created page with "{{subst:Medical Record}}")
 
 
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|width="600" colspan=2|[[File:Starfleet Medical.png|right|150px|link=Category:Medical Records]]
 
|width="600" colspan=2|[[File:Starfleet Medical.png|right|150px|link=Category:Medical Records]]
===LAST NAME, FIRST NAME MIDDLE NAME===
+
===SHEDET===
 
*'''[[StarFleet Serial Number Register|Patient Reference Number:]]''' EZ - 123 - 456
 
*'''[[StarFleet Serial Number Register|Patient Reference Number:]]''' EZ - 123 - 456
 
*'''Date of Birth:'''
 
*'''Date of Birth:'''
 
**'''Age:''' {{age|2360|03|31}}
 
**'''Age:''' {{age|2360|03|31}}
*'''Sex:'''
+
*'''Sex:''' Female
*'''Species:'''
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*'''Species:''' Orion
 
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*'''Height:''' 178 cm (5'10")
 
*'''Height:''' 178 cm (5'10")
 
*'''Weight:''' 73 kilos (160 lbs)
 
*'''Weight:''' 73 kilos (160 lbs)
*'''Blood Type:'''
+
*'''Blood Type:''' E+
*'''[[T/E Rating]]:'''
+
*'''[[T/E Rating]]:''' T0/E0
 
|-
 
|-
 
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===PAST MEDICAL HISTORY===
 
===PAST MEDICAL HISTORY===
 
*'''Chronic Illnesses:'''
 
*'''Chronic Illnesses:'''
*'''Medications:'''
+
*'''Medications:''' Ordivolus (Anti-pheromone treatment)
*'''Allergies and Reactions:'''
+
*'''Allergies and Reactions:''' No Known Allergies
*'''Sexual/Reproductive History:'''
+
*'''Sexual/Reproductive History:''' Declined to Respond
 
|-
 
|-
 
|style="background:teal;"|
 
|style="background:teal;"|
 
|colspan=2|
 
|colspan=2|
 
===PAST HOSPITALIZATIONS/SERIOUS ILLNESS===
 
===PAST HOSPITALIZATIONS/SERIOUS ILLNESS===
*'''SD 237005.05:'''
 
*'''SD 237007.05:'''
 
  
 
===PAST SURGICAL HISTORY===
 
===PAST SURGICAL HISTORY===
*'''SD 237005.05:'''
+
 
*'''SD 237007.05:'''
 
 
|-
 
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===SUBSTANCE USE HISTORY===
 
===SUBSTANCE USE HISTORY===
*'''Alcohol:'''
+
*'''Alcohol:''' Declined to Respond
*'''Recreation Drugs:'''
+
*'''Recreation Drugs:''' No drug usage.
*'''Other:'''
+
*'''Other:'''  
 
|-
 
|-
 
|style="background:teal;"|
 
|style="background:teal;"|
 
|colspan=2|
 
|colspan=2|
 
===FAMILY MEDICAL HISTORY===
 
===FAMILY MEDICAL HISTORY===
*'''Mother:'''
+
*'''Mother:''' Maveth
*'''Father:'''
+
*'''Father:''' Kosek
*'''Siblings:'''
+
*'''Siblings:''' Declined to Respond
 
|-
 
|-
 
|style="background:teal;"|
 
|style="background:teal;"|
 
|colspan=2|
 
|colspan=2|
 
===SOCIAL HISTORY===
 
===SOCIAL HISTORY===
*'''Marital status:'''
+
*'''Marital status:''' Single
*'''Children:'''
+
*'''Children:''' None
*'''Occupation/Assignment:'''
+
*'''Occupation/Assignment:''' Science Office on the [[USS Victory]].
*'''Diet:'''
+
*'''Diet:''' Normal
*'''Exercise:'''
+
*'''Exercise:''' Moderate
 
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|colspan=2|
 
|colspan=2|
 
===PHYSICIANS' NOTES===
 
===PHYSICIANS' NOTES===
*'''Medical Officer:'''
+
*'''Medical Officer:'''  
 
*'''Medical Assessment:'''
 
*'''Medical Assessment:'''
 
|-
 
|-

Latest revision as of 23:40, 20 August 2014

Starfleet Medical.png

SHEDET

MEDICAL RECORD
  • Height: 178 cm (5'10")
  • Weight: 73 kilos (160 lbs)
  • Blood Type: E+
  • T/E Rating: T0/E0

PAST MEDICAL HISTORY

  • Chronic Illnesses:
  • Medications: Ordivolus (Anti-pheromone treatment)
  • Allergies and Reactions: No Known Allergies
  • Sexual/Reproductive History: Declined to Respond

PAST HOSPITALIZATIONS/SERIOUS ILLNESS

PAST SURGICAL HISTORY

PSYCHIATRIC HISTORY

SUBSTANCE USE HISTORY

  • Alcohol: Declined to Respond
  • Recreation Drugs: No drug usage.
  • Other:

FAMILY MEDICAL HISTORY

  • Mother: Maveth
  • Father: Kosek
  • Siblings: Declined to Respond

SOCIAL HISTORY

  • Marital status: Single
  • Children: None
  • Occupation/Assignment: Science Office on the USS Victory.
  • Diet: Normal
  • Exercise: Moderate

PHYSICIANS' NOTES

  • Medical Officer:
  • Medical Assessment:

COUNSELORS' NOTES

  • Counselor:
  • Psychological Assessment: