3,599
edits
Robin Hopper/Medical Record: Difference between revisions
Jump to navigation
Jump to search
m
no edit summary
(Created page with "{{UnderConstruction|Kivik}} {{subst:Medical Record}}") |
mNo edit summary |
||
| Line 1: | Line 1: | ||
{{UnderConstruction|Kivik}} | {{UnderConstruction|Kivik}} | ||
{{Medical Record LCARS | {{Medical Record LCARS | ||
|SERIAL NUMBER= | |SERIAL NUMBER= | ||
|BIRTHYEAR= | |BIRTHYEAR= | ||
|BIRTHMONTH= | |BIRTHMONTH= | ||
|BIRTHDATE= | |BIRTHDATE= | ||
|SEX= Female | |SEX= Female | ||
|SPECIES= [[Human]] | |SPECIES= [[Human]] / [[Centauran]] | ||
|HEIGHT= | |HEIGHT= | ||
|WEIGHT= | |WEIGHT= | ||
|BLOOD TYPE= | |BLOOD TYPE= | ||
|T/E RATING= | |T/E RATING= | ||
|CHRONIC ILLNESSES= | |CHRONIC ILLNESSES= | ||
|MEDICATIONS= | |MEDICATIONS= | ||
|ALLERGIES & REACTIONS= | |ALLERGIES & REACTIONS= | ||
|SEXUAL/REPRODUCTIVE HISTORY= | |SEXUAL/REPRODUCTIVE HISTORY= | ||
|PAST HOSPITALIZATIONS/SERIOUS ILLNESS= | |PAST HOSPITALIZATIONS/SERIOUS ILLNESS= | ||
* | * | ||
|PAST SURGICAL HISTORY= | |PAST SURGICAL HISTORY= | ||
* | * | ||
|PSYCHIATRIC HISTORY= | |||
|ALCOHOL USE= | |||
|RECREATIONAL DRUG USE= | |||
|PSYCHIATRIC HISTORY= | |OTHER SUBSTANCE USE= | ||
|ALCOHOL USE= | |MOTHER MEDICAL HISTORY= | ||
|RECREATIONAL DRUG USE= | |FATHER MEDICAL HISTORY= | ||
|OTHER SUBSTANCE USE= | |SIBLING MEDICAL HISTORY= | ||
|MOTHER MEDICAL HISTORY= | |MARITAL STATUS & SPOUSE= | ||
|FATHER MEDICAL HISTORY= | |CHILDREN= | ||
|SIBLING MEDICAL HISTORY= | |OCCUPATION= | ||
|MARITAL STATUS & SPOUSE= | |DIET= | ||
|CHILDREN= | |EXERCISE= | ||
|OCCUPATION= | |||
|DIET= | |||
|EXERCISE= | |||
|PHYSICIANS NOTE= | |PHYSICIANS NOTE= | ||
* | * | ||
|COUNSELORS NOTE= | |COUNSELORS NOTE= | ||
* | * | ||
}} | }} | ||
[[Category:Medical Records]] | [[Category:Medical Records]] | ||