| PATIENT MEDICAL HISTORY | ||||
| Name: Uva | Age: 800 years | Sex: Male | Height: ??inch/cm | Weight: ??lbs/kg |
| [X] Magical by nature/practices magic. | [ ] Can't have magic used on. | [ ] Contagious (see notes). | ||
| GREEED | ||||
| Average Lifespan: Can't die via aging. | Rate of Maturity: Species does not physically mature, mental ages vary among individuals. | Average age of Puberty: No. | ||
| Normal Diet:Common Ailments: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] None | [ ] Average | [ ] Low | [ ] High | ||||
| Vision: [X] Irregular | [ ] Fine | [ ] Near Sighted | [ ] Far Sighted | [ ] Enhanced | ||||
| If Enhanced, further explain: Badly blurred and slightly-double imaged vision, with extremely dulled colors save for green. | ||||
| Hearing: [ ] Deaf | [X] Low | [ ] Average | [ ] High Range | [ ] Low Range | [ ] Extremely Sensitive | ||||
| If necessary, further explain: | ||||
| Smell: [ ] Cannot Smell | [ ] Low | [ ] 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?: Destroyed core medals are irreplaceable and even less all-out damage to them is impossible to fix, while lost cell medals are easily gathered anew. 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?: Special notes on care: (Such as contagious diseases/conditions, special means of handling, special care taken in handling) Record of Past Injuries: Ship Health Records: | ||||
| SEXUAL HEALTH | ||||
| Have you ever been sexually active?: lol Are you currently Sexually Active: lol Have you recently been screened for STIs?: lol Species specific sexually related health notes and/or issues: lol | ||||
| DRUGS AND MEDICATION | ||||
| Are you or should you be on any prescribed medication? If so, list below: 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: Do you currently take any recreational or non-prescribed drugs or substances? Is so, please list them and their frequency of use below: | ||||