dragonlordbight: (Bight!Oh really?)
[personal profile] dragonlordbight
PATIENT MEDICAL HISTORY
Name: Hogan Bight Age:  63 years Sex: Male Height:  6'3"/190.5 in/cm Weight: 188/85 lbs/kg
[x] Magical by nature/practices magic. [ ] Can't have magic used on. [ ] Contagious (see notes).
SPECIES NAME HERE
Average Lifespan: 80 Rate of Maturity: 18 Average age of Puberty: 12

Normal Diet:  Standard human dietary needs. Find full documentation [here].


Common Ailments:  See file on [Common Human Illnesses].


Specific Notes: (healing factors, special needs, etc)
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.
Blood Pressure: [x] Average | [ ] Low | [ ] High
Vision: [x] Fine | [ ] Near Sighted | [ ] Far Sighted | [ ] Enhanced
If Enhanced, further explain:
Hearing: [ ] Deaf | [ ] Low | [x] Average | [x] High Range | [x] Low Range | [ ] Extremely Sensitive
If necessary, further explain: 
Smell: [ ] Cannot Smell | [ ] Low | [x] Average | [ ] High | [ ] Extremely Sensitive
If Extremely Sensitive, further explain:
Known Allergies:  None


Are there any potential complications with healing processes we should be aware of when treating you?:  None


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?:  No


Special notes on care: (Such as contagious diseases/conditions, special means of handling, special care taken in handling) No



Record of Past Injuries:  Only minor injuries and cuts.


Ship Health Records:  None
SEXUAL HEALTH
Have you ever been sexually active?:  Yes

Are you currently Sexually Active:  No

Have you recently been screened for STIs?:  No


Species specific sexually related health notes and/or issues:  None
Reproductive Health (skip if N/A)
Date of Last Menses/Estrus/Equiv (skip if n/a):

Number of pregnancies:

Number of pregnancies carried to term:

Age of first birth/hatching/etc. (if applicable):

Total number of births/hatching/etc.:
DRUGS AND MEDICATION
Are you or should you be on any prescribed medication? If so, list below: No


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, daily


Do you currently take any recreational or non-prescribed drugs or substances? Is so, please list them and their frequency of use below: Alcohol, on occasion
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dragonlordbight

February 2013

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