IC Medical record
PATIENT MEDICAL HISTORY | ||||
Name: Ted | Age: 10 years | Sex: Male | Height: 127 cm | Weight: 31 kg |
[ x ] Magical by nature/practices magic. | [ ] Can't have magic used on. | [ ] Contagious (see notes). | ||
DEMON | ||||
Average Lifespan: 1000~ | Rate of Maturity: Varies | Average age of Puberty: Varies | ||
Normal Diet: Human's average diet Common Ailments: Cold, fevers, etc Specific Notes: The general lifespan, maturity rate and average age of puberty are variable due to the species having variable appearances. Some appearing identical to humans while others may seem beastly. Certain types of this species have special abilities apart from their own spell, such as some form of clairvoyance to shape-shifting, also varies. Commonly, all posses a faster healing rate than the average human. |
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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 | [ ] Average | [ ] High | [ x ] Extremely Sensitive | ||||
If Extremely Sensitive, further explain: Species naturally have more sensitive senses, patient in particular posses extremely sensitive sense of smell |
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Known Allergies: 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: None Record of Past Injuries: Several small scars are located around the patient's body. Ship Health Records: Currently healthy and no injuries or accident as of yet |
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SEXUAL HEALTH | ||||
Have you ever been sexually active?: ? Are you currently Sexually Active: ?? Have you recently been screened for STIs?: ??? Species specific sexually related health notes and/or issues: ???? |
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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.: |
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DRUGS AND MEDICATION | ||||
Are you or should you be on any prescribed medication? If so, list below: None 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: No Do you currently take any recreational or non-prescribed drugs or substances? Is so, please list them and their frequency of use below: No |