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{| border='1' cellspacing='0'
{|style="max-width:700px"
|style="background:teal;" width="100"|
|width="600" colspan=2|[[File:Starfleet Medical.png|right|150px|link=Category:Medical Records]]
===LAST NAME, FIRST NAME MIDDLE NAME===
*'''[[StarFleet Serial Number Register|Patient Reference Number:]]''' EZ - 123 - 456
*'''Date of Birth:'''
**'''Age:''' {{age|2360|03|31}}
*'''Sex:'''
*'''Species:'''
|-
|-
|style="background:teal; border-radius: 0 0 0 14px; border:0px solid #AFA3BF"|
! style="background:#ffdead; width:50px;" |'''Deck'''
|style="background:teal" |
! style="background:#deffad; width:300px;" |'''Facilities'''
!width=180 align=right|<font size="4" color=teal>MEDICAL RECORD</font>
! style="background:#addeff; width:200px;" |'''Images'''
|-
|-
|style="background:teal; border-radius: 14px 0 0 0; border:0px solid #AFA3BF"|
|'''Deck 1'''
|colspan=2|
|
*'''Height:''' 178 cm (5'10")
*Main Bridge
*'''Weight:''' 73 kilos (160 lbs)
*Captain's Ready Room
*'''Blood Type:'''
*Conference Room
*'''[[T/E Rating]]:'''
*Transporter Room 1
!
|-
|-
|style="background:teal;"|
|'''Deck 2'''
|colspan=2|
|
===PAST MEDICAL HISTORY===
*Sensor Maintenance
*'''Chronic Illnesses:'''
*First Officer's Quarters
*'''Medications:'''
*VIP Quarters
*'''Allergies and Reactions:'''
!
*'''Sexual/Reproductive History:'''
|-
|-
|style="background:teal;"|
|'''Deck 3'''
|colspan=2|
|
===PAST HOSPITALIZATIONS/SERIOUS ILLNESS===
*Security / Main Armory
*'''SD 237005.05:'''
*Chief of Security's Office
*'''SD 237007.05:'''
*Transporter Rooms 2 - 5
 
!
===PAST SURGICAL HISTORY===
*'''SD 237005.05:'''
*'''SD 237007.05:'''
|-
|-
|style="background:teal;"|
|'''Deck 4'''
|colspan=2|
|
===PSYCHIATRIC HISTORY===
* Main Shuttlebay
 
* Senior Officers' Quarters
===SUBSTANCE USE HISTORY===
* Captain's Quarters
*'''Alcohol:'''
!
*'''Recreation Drugs:'''
*'''Other:'''
|-
|-
|style="background:teal;"|
|'''Deck 5'''
|colspan=2|
|
===FAMILY MEDICAL HISTORY===
* Crew Quarters
*'''Mother:'''
<div class="mw-collapsible mw-collapsed">
*'''Father:'''
* Auxiliary Deflector Control Room
*'''Siblings:'''
</div>
!
|-
|-
|style="background:teal;"|
|'''Deck 6'''
|colspan=2|
|
===SOCIAL HISTORY===
* [[Excalibur Diplomatic Facilities|Diplomatic Facilities]]
*'''Marital status:'''
* VIP Quarters
*'''Children:'''
* Officer’s Mess/Galley/Banquet Hall
*'''Occupation/Assignment:'''
!
*'''Diet:'''
*'''Exercise:'''
|-
|-
|style="background:teal;" colspan=3 height=4|
|'''Deck 7'''
|
* Main Shuttlebay
* [[Excalibur Sickbay|Sickbay and Surgical Wards]]
<div class="mw-collapsible mw-collapsed">
* Auxiliary Deflector Control
</div>
!
|-
|-
|style="background:teal;"|
|'''Deck 8'''
|colspan=2|
|
===PHYSICIANS' NOTES===
* Main Shuttlebay
*'''Medical Officer:'''
* Crew Quarters
*'''Medical Assessment:'''
<div class="mw-collapsible mw-collapsed">
* Port and Starboard Docking Airlocks
</div>
!
|-
|'''Deck 9'''
|
* Crew Quarters
* Auxiliary Control Room
* Science Labs
* Marine Fighter Bay
<div class="mw-collapsible mw-collapsed">
* Main Computer Control
</div>
!
|-
|'''Deck 10'''
|
* Shuttlebay Two
* [[Excalibur Main Lounge|The Round Table]]
* [[Excalibur Science Labs|Science Labs]]
* [[Excalibur Astrometrics|Astrometrics]]
<div class="mw-collapsible mw-collapsed">
* Deuterium Injection Reactors
* Impulse Engines
</div>
!
|-
|-
|style="background:teal;"|
|colspan=2|
===COUNSELORS' NOTES===
*'''Counselor:'''
*'''Psychological Assessment:'''
|}
|}
__NOTOC__
[[Category:Medical Records]]
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