coldfire_adeptcoldfire_adeptcoldfire_adeptcoldfire_adept| PATIENT MEDICAL HISTORY | ||||
| Name: Gerald Tarrant | Age: Approximately 1,000 years | Sex: male | Height: 72 inch/182.9 cm | Weight: 160 lbs/72.6 kg |
| [x] Magical by nature/practices magic. | [ ] Can't have magic used on. | [ ] Contagious (see notes). | ||
| UNDEAD | ||||
| Average Lifespan: N/A | Rate of Maturity: N/A | Average age of Puberty: 13 | ||
Normal Diet: Human fear. Human blood is an acceptable temporary substitute. Common Ailments: N/A Specific Notes: Must be kept out of direct sunlight. Capable of rapid tissue regeneration after sun exposure. |
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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: [ ] Average | [x] 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 | [x] High | [ ] Extremely Sensitive | ||||
| If Extremely Sensitive, further explain: |
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| Known Allergies: Sunlight Are there any potential complications with healing processes we should be aware of when treating you?: I would be best served if you would avoid attempting to heal me at all by magical means. You would likely do far more harm than good. Do you have a healing factor different from the average for your species? If so, explain how here: No. However, I am capable of regenerating damage sustained to my body. Have you recently been screened for species, sex, and age specific cancer risks?: N/A Special notes on care: If severely damaged, a steady supply of human blood will aid the healing process Record of Past Injuries: (a long and extensive list!) Ship Health Records: N/A |
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| 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: N/A |
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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: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: 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 |
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