Trans_9 - Medical Records
Jul. 15th, 2011 01:02 am![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png)
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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 |