Template:Medical Record/Example

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{{{{Medical Record LCARS
|SERIAL NUMBER= HC-018-080
|BIRTHYEAR= 2371
|BIRTHMONTH= 09
|BIRTHDATE= 02
|SEX= Female
|SPECIES= [[Human]] / [[Centauran]]
|HEIGHT= 1.67 m
|WEIGHT= 54 kg
|BLOOD TYPE= AB positive
|T/E RATING= T0/E0
|CHRONIC ILLNESSES= None
|MEDICATIONS= Receiving regular contraceptive injections
|ALLERGIES & REACTIONS= Possible intolerance for certain grains (i.e. hops)
|SEXUAL/REPRODUCTIVE HISTORY= Active, no pregnancies
|PAST HOSPITALIZATIONS/SERIOUS ILLNESS=
*None
|PAST SURGICAL HISTORY=
*'''2371''': At birth, left leg amputation (due to complications)
*'''2372''': At 8 months, bioelectrical implantation for neurologically-controlled prosthesis
*'''2390''': At 19 years, wisdom teeth removal
|PSYCHIATRIC HISTORY= 
*None, regular counselling
|ALCOHOL USE= Occasional
|RECREATIONAL DRUG USE= None
|OTHER SUBSTANCE USE= Mild caffeine intake
|PARENT 1 = Birth Mother
|PARENT 1 MEDICAL HISTORY= Melissa Hopper (Human),  civilian file not available without requisition
|PARENT 2 = Biological Mother
|PARENT 2 MEDICAL HISTORY= Ansyra Hopper (Centauran), civilian file not available without requisition
|SIBLING MEDICAL HISTORY= Kerilyn Hopper (Human/Centauran), civilian file not available without requisition
|MARITAL STATUS & SPOUSE= Single
|CHILDREN= None
|OCCUPATION= Chief Science Officer, [[Amity Outpost]]
|DIET= Vegetarian
|EXERCISE= Typical aerobics, cardiovascular health optimal
|PHYSICIANS NOTE=
*'''239708.11 - Dr. Duran Larx''' (CMO, [[USS Wall Street]]): Ensign Hopper's health is excellent; Routine check-ups recommended.
*
|COUNSELORS NOTE=
* None on file
}}
Starfleet Medical.png

Medical Record

MEDICAL RECORD
  • Height: 1.67 m
  • Weight: 54 kg
  • Blood Type: AB positive
  • T/E Rating: T0/E0

PAST MEDICAL HISTORY

  • Chronic Illnesses: None
  • Medications: Receiving regular contraceptive injections
  • Allergies and Reactions: Possible intolerance for certain grains (i.e. hops)
  • Sexual/Reproductive History: Active, no pregnancies

PAST HOSPITALIZATIONS/SERIOUS ILLNESS

  • None

PAST SURGICAL HISTORY

  • 2371: At birth, left leg amputation (due to complications)
  • 2372: At 8 months, bioelectrical implantation for neurologically-controlled prosthesis
  • 2390: At 19 years, wisdom teeth removal

PSYCHIATRIC HISTORY

  • None, regular counselling

SUBSTANCE USE HISTORY

  • Alcohol: Occasional
  • Recreation Drugs: None
  • Other: Mild caffeine intake

FAMILY MEDICAL HISTORY

  • Parent 1 (Birth Mother): Melissa Hopper (Human), civilian file not available without requisition
  • Parent 2 (Biological Mother): Ansyra Hopper (Centauran), civilian file not available without requisition
  • Siblings: Kerilyn Hopper (Human/Centauran), civilian file not available without requisition

SOCIAL HISTORY

  • Marital status: Single
  • Children: None
  • Occupation/Assignment: Chief Science Officer, Amity Outpost
  • Diet: Vegetarian
  • Exercise: Typical aerobics, cardiovascular health optimal

PHYSICIANS' NOTES

  • 239708.11 - Dr. Duran Larx (CMO, USS Wall Street): Ensign Hopper's health is excellent; Routine check-ups recommended.

COUNSELORS' NOTES

  • None on file