} Initial Physical
Jul. 17th, 2011 01:26 am![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png)
PATIENT MEDICAL HISTORY | ||||
Name: Sumeragi Lee Noriega | Age: 31 years | Sex: F | Height: 5'4"/ 163 cm | Weight: 157 lbs/ 71 kg |
[ ] Magical by nature/practices magic. | [ ] Can't have magic used on. | [ ] Contagious (see notes). | ||
Human | ||||
Average Lifespan: 90-95 years | Rate of Maturity: ~18 years | Average age of Puberty: Onset at 12 years | ||
Normal Diet: Standard human dietary needs. Find full documentation [here]. Common Ailments: Colds, fevers, poxes. See file on [Common Human Illnesses]. Specific Notes: None |
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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. |
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Blood Pressure: [x] Average | [ ] Low | [ ] High | ||||
Vision: [x] Fine | [ ] Near Sighted | [ ] Far Sighted | [ ] Enhanced | ||||
If Enhanced, further explain: |
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Hearing: [ ] Deaf | [ ] Low | [x] Average | [ ] High Range | [ ] Low Range | [ ] Extremely Sensitive | ||||
If necessary, further explain: |
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Smell: [ ] Cannot Smell | [ ] Low | [x] Average | [ ] High | [ ] Extremely Sensitive | ||||
If Extremely Sensitive, further explain: |
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Known Allergies: Mild hayfever, mild contact allergy to nickel Are there any potential complications with healing processes we should be aware of when treating you?: No 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: Patient has spent long periods of time in low-gravity environment, and displays minor weightlessness-related bone mass loss. Some evidence of cirrhosis, likely due to long-term alcohol use. Recommend additional screening before prescription of hepatotoxic drugs. Record of Past Injuries: Broken ankle at age 13, no lasting effects. No other serious injuries or illnesses Ship Health Records: N/A |
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SEXUAL HEALTH | ||||
Have you ever been sexually active?: Yes Are you currently Sexually Active: No; likely to be in the near future Have you recently been screened for STIs?: Yes Species specific sexually related health notes and/or issues: None |
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Reproductive Health (skip if N/A) | ||||
Date of Last Menses/Estrus/Equiv: 6 mo. previous to arrival (hormonal contraceptives) Number of pregnancies: 0 Number of pregnancies carried to term: 0 Age of first birth/hatching/etc. (if applicable): 0 Total number of births/hatching/etc.: 0 |
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DRUGS AND MEDICATION | ||||
Are you or should you be on any prescribed medication? If so, list below: Hormonal contraceptives 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: Occasional marijuana use during college, none in the past ten years. One prior use of LSD. Drinks alcohol regularly Do you currently take any recreational or non-prescribed drugs or substances? Is so, please list them and their frequency of use below: Moderate alcohol consumption, 4-5 times a week |