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| <includeonly>{|style="max-width:700px" | | <onlyinclude><noinclude>{{{NO INCLUDE|}}}</noinclude><includeonly>{{{INCLUDE ONLY|}}}</includeonly></onlyinclude><noinclude>[[Category:Adingo]]</noinclude> |
| |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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| | |
| ===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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| | |
| ===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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| *'''Mother:''' {{{MOTHER MEDICAL HISTORY|}}}
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| *'''Father:''' {{{FATHER 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> | |
| <noinclude>[[Category:Adingo]]</noinclude> | |