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| <includeonly>{|style="max-width:700px"
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| |style="background:teal;" width="100"|
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| |width="600" colspan=2|[[File:Starfleet Medical.png|right|150px|link=Category:Medical Records]]
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| ===<span style="text-transform:uppercase;">{{BASEPAGENAME}}</span>===
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| *'''[[StarFleet Serial Number Register|Patient Reference Number:]]''' {{{SERIAL NUMBER|}}}
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| *'''Date of Birth:''' {{{BIRTHYEAR|}}}{{{BIRTHMONTH|}}}.{{{BIRTHDATE|}}}
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| **'''Age:''' {{age|{{{BIRTHYEAR|}}}|{{{BIRTHMONTH|}}}|{{{BIRTHDATE|}}}}}
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| *'''Sex:''' {{{SEX|}}}
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| *'''Species:''' {{{SPECIES|}}}
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| |-
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| |style="background:teal; border-radius: 0 0 0 14px; border:0px solid #AFA3BF"|
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| |style="background:teal" |
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| !width=180 align=right style="line-height: 130%;"|<font size="4" color=teal>MEDICAL RECORD</font>
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| |-
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| |style="background:teal; border-radius: 14px 0 0 0; border:0px solid #AFA3BF"|
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| |colspan=2|
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| *'''Height:''' {{{HEIGHT|}}}
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| *'''Weight:''' {{{WEIGHT|}}}
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| *'''Blood Type:''' {{{BLOOD TYPE|}}}
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| *'''[[T/E Rating]]:''' {{{T/E RATING|}}}
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| |-
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| |style="background:teal;"|
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| |colspan=2|
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| ===PAST MEDICAL HISTORY===
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| *'''Chronic Illnesses:''' {{{CHRONIC ILLNESSES|}}}
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| *'''Medications:''' {{{MEDICATIONS|}}}
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| *'''Allergies and Reactions:''' {{{ALLERGIES & REACTIONS|}}}
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| *'''Sexual/Reproductive History:''' {{{SEXUAL/REPRODUCTIVE HISTORY|}}}
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| |-
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| |style="background:teal;"|
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| |colspan=2|
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| ===PAST HOSPITALIZATIONS/SERIOUS ILLNESS===
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| {{{PAST HOSPITALIZATIONS/SERIOUS ILLNESS|}}}
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|
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| ===PAST SURGICAL HISTORY===
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| {{{PAST SURGICAL HISTORY|}}}
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| |-
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| |style="background:teal;"|
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| |colspan=2|
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| ===PSYCHIATRIC HISTORY===
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| {{{PSYCHIATRIC HISTORY|}}}
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|
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| ===SUBSTANCE USE HISTORY===
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| *'''Alcohol:''' {{{ALCOHOL USE|}}}
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| *'''Recreation Drugs:''' {{{RECREATIONAL DRUG USE|}}}
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| *'''Other:''' {{{OTHER SUBSTANCE USE|}}}
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| |-
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| |style="background:teal;"|
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| |colspan=2|
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| ===FAMILY MEDICAL HISTORY===
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| {{#if: {{{MOTHER MEDICAL HISTORY|}}}{{{PARENT 1|}}}|*'''Parent 1 ({{#if: {{{MOTHER MEDICAL HISTORY|}}}|Mother|{{{PARENT 1|}}}}}):''' {{#if: {{{MOTHER MEDICAL HISTORY|}}}|{{{MOTHER MEDICAL HISTORY|}}}|{{{PARENT 1 MEDICAL HISTORY|}}}}}}}{{#if:||
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| {{#if: {{{FATHER MEDICAL HISTORY|}}}{{{PARENT 2|}}}|*'''Parent 2 ({{#if: {{{FATHER MEDICAL HISTORY|}}}|Father|{{{PARENT 2|}}}}}):''' {{#if: {{{FATHER MEDICAL HISTORY|}}}|{{{FATHER MEDICAL HISTORY|}}}|{{{PARENT 2 MEDICAL HISTORY|}}}}}}}}}{{#if:||
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| {{#if: {{{PARENT 3|}}}|*'''Parent 3 ({{{PARENT 3|}}}):''' {{{PARENT 3 MEDICAL HISTORY|}}}}}}}{{#if:||
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| {{#if: {{{PARENT 4|}}}|*'''Parent 4 ({{{PARENT 4|}}}):''' {{{PARENT 4 MEDICAL HISTORY|}}}}}}}
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| *'''Siblings:''' {{{SIBLING MEDICAL HISTORY|}}}
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| |-
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| |style="background:teal;"|
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| |colspan=2|
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| ===SOCIAL HISTORY===
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| *'''Marital status:''' {{{MARITAL STATUS & SPOUSE|}}}
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| *'''Children:''' {{{CHILDREN|}}}
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| *'''Occupation/Assignment:''' {{{OCCUPATION|}}}
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| *'''Diet:''' {{{DIET|}}}
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| *'''Exercise:''' {{{EXERCISE|}}}
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| |-
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| |style="background:teal;" colspan=3 height=4|
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| |-
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| |style="background:teal;"|
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| |colspan=2|
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| ===PHYSICIANS' NOTES===
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| {{{PHYSICIANS NOTE|}}}
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| |-
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| |style="background:teal;" colspan=3 height=4|
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| |-
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| |style="background:teal;"|
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| |colspan=2|
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| ===COUNSELORS' NOTES===
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| {{{COUNSELORS NOTE|}}}
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| |}
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| __NOEDITSECTION__
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| __NOTOC__
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| </includeonly>
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| <noinclude>
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| {{User:Noa T'Nessa Levinson/Sandbox5
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| |SERIAL NUMBER= EZ - 123 - 456
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| |BIRTHYEAR= 2363
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| |BIRTHMONTH= 01
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| |BIRTHDATE= 01
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| |SEX= Female
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| |SPECIES= [[Human]]
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| |HEIGHT= 161 cm (5'3")
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| |WEIGHT= 56 kilos (123 lbs)
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| |BLOOD TYPE= B+
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| |T/E RATING= T0
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| |CHRONIC ILLNESSES= None
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| |MEDICATIONS= None
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| |ALLERGIES & REACTIONS= Strawberries (hives)
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| |SEXUAL/REPRODUCTIVE HISTORY= Longterm male partner
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| |PAST HOSPITALIZATIONS/SERIOUS ILLNESS=
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| *'''2388:''' Tarkalean flu
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| |PAST SURGICAL HISTORY=
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| *'''SD 238911.12:''' Knee surgery
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| **'''Surgeon:''' {{n|Niccolò|del Vedova}}, MD
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| **'''OR Site:''' {{USS|Mercury}}
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| **'''Op Note:''' Link to sim
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| |PSYCHIATRIC HISTORY= None
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| |ALCOHOL USE= 2 glasses of wine per week
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| |RECREATIONAL DRUG USE= None
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| |OTHER SUBSTANCE USE= None
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| |PARENT 1= Mother
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| |PARENT 1 MEDICAL HISTORY= Yes this is history
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| |PARENT 2= Father
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| |PARENT 2 MEDICAL HISTORY= Yes this is also history
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| |PARENT 3= hmmmmm
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| |PARENT 3 MEDICAL HISTORY= No thank you
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| |SIBLING MEDICAL HISTORY= None
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| |MARITAL STATUS & SPOUSE= Married to Elliot Smith
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| |CHILDREN= 1 son
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| |OCCUPATION= Helmsman
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| |DIET= Vegetarian
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| |EXERCISE= Running, 3 times a week
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| |PHYSICIANS NOTE=
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| *'''SD 239004.23 - Medical Officer:''' {{n|Niccolò|del Vedova}}, MD, {{USS|Mercury}}
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| *'''Medical Assessment:''' Ensign Smith is a 27-year-old human female who presents with abdominal pain and generalized weakness. She states the symptoms began last Thursday after eating a bowl of Commander McLaughin's "Sweet Chili Surprise" at the ship's annual cook off contest. I've started her on an intense bowel cleansing therapy which should be followed to completion through next week.
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| <hr>
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| *'''SD 239004.27 - Medical Officer:''' {{n|Niccolò|del Vedova}}, MD, {{USS|Mercury}}
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| *'''Addendum:''' Ensign Smith returned to sickbay today stating she felt much better, insisting that her cleansing therapy was no longer necessary. I told her nonsense and sent her on her way.
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| |COUNSELORS NOTE=
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| *'''SD 239004.28 - Counselor:''' Lt. Rachel Simmons, {{USS|Mercury}}
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| *'''Counseling Assessment:''' Ensign Smith came to my office today in tears. It seems her recent medical illness due to her unfortunate encounter with McLaughlin's chili has left her feeling vulnerable and alone. I have advised her to continue daily therapy sessions with me until further notice.
| |
| }}
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| [[Category:Adingo]]</noinclude> | | [[Category:Adingo]]</noinclude> |