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Medical Chart for [livejournal.com profile] trans_9
PATIENT MEDICAL HISTORY
Name: Sandrilene fa Toren Age: 17 years Sex: Female Height: 5'4" Weight: 110 lbs
[X] Magical by nature/practices magic. [ ] Can't have magic used on. [ ] Contageous (see notes).
Human
Average Lifespan: 80 years Rate of Maturity: 18-25 years Average age of Puberty: 12 years

Normal Diet: Vegetables, meats, fruits, and grains.  No alcohol.


Common Ailments: Colds, fevers, poxes


Specific Notes: Mage. Alcohol is known to cause a potentially disastrous flare of magic. Other drugs and medicines may have similar effects: prescribe with caution.

GENERAL HEALTH
All of the following sense-related questions are to be answered in comparison to an average Homo sapiens. Ask your medical provider for assistance in answering this section.
Vision: [X] Fine | [ ] Near Sighted | [ ] Far Sighted | [X] Enhanced Blood Pressure: [X] Average | [ ] Low | [ ] High
If Enhanced, further explain: Sees magic.  Vision is otherwise normal.
Hearing: [ ] Deaf | [ ] Low | [X] Average | [ ] High Range | [ ] Low Range | [ ] Extremely Sensitive
If necessary, further explain:  N/A
Smell: [ ] Cannot Smell | [ ] Low | [X] Average | [ ] High | [ ] Extremely Sensitive
If Extremely Sensitive, further explain:  N/A
Known Allergies: None

Are there any potential complications with healing processes we should be aware of when treating you?: Possible interference of magic.


Do you have a healing factor different from the average for your species? If so, explain how here: No


Have you recently been screened for species, sex, and age specific cancer risks?: Yes.


Special notes on care: None


Record of Past Injuries: Mild stress and malnutrition for several weeks at the age of ten.  Multiple cases of power exhaustion.


Ship Health Records:

SEXUAL HEALTH
Date of Last Menses/Estrus/Equiv (skip if n/a): Approximately eight days past.

Have you ever been sexually active?: No

Are you currently Sexually Active: No

Have you recently been screened for STIs?: No

Species specific sexually related health notes and/or issues: None

DRUGS AND MEDICATION
Are you or should you be on any prescribed medication? If so, list below: N/A

Have you taken any recreational or non-prescribed drugs or substances in the past? Is so, please list them and their frequency of use below: Alcohol, once.


Do you currently take any recreational or non-prescribed drugs or substances? Is so, please list them and their frequency of use below: N/A

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Sandrilene fa Toren

November 2011

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