Hogan Bight -Medical Records
Jul. 16th, 2011 08:10 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png)
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 |