|PATIENT MEDICAL HISTORY|
|Name: Eva Salazar||Age: 48 years||Sex: F||Height: 5'6inch||Weight: 152lbs/kg|
|[ ] Magical by nature/practices magic.||[ ] Can't have magic used on.||[ ] Contagious (see notes).|
|Average Lifespan: 73||Rate of Maturity: 18 years||Average age of Puberty: 12 years|
Normal Diet: Standard human diet. See file.
Common Ailments: Common human illnesses. See file.
Specific Notes: None.
|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: [ ] Average | [ ] Low | [x] High|
|Vision: [ ] Fine | [ ] Near Sighted | [ ] Far Sighted | [x] Enhanced|
| If Enhanced, further explain: Reading glasses.
|Hearing: [ ] Deaf | [ ] Low | [x] Average | [ ] High Range | [ ] 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?: Yes.
Special notes on care: No treatment to neck or ear injuries unless emergency.
Record of Past Injuries: Extensive physical trauma (see file). Was in physical therapy on homeworld; discontinued.
Ship Health Records: Demonic possession (exorcised). See file.
Have you ever been sexually active?: Yes.
Are you currently Sexually Active: No.
Have you recently been screened for STIs?: Yes.
Species specific sexually related health notes and/or issues: One pregnancy carried to term (age 28).
|Date of Last Menses/Estrus/Equiv (skip if n/a): Within the last month.
Number of pregnancies: One.
Number of pregnancies carried to term: One.
Age of first birth/hatching/etc. (if applicable): 28.
Total number of births/hatching/etc.: One.
|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: None.
Do you currently take any recreational or non-prescribed drugs or substances? Is so, please list them and their frequency of use below: Alcohol, recreational, 5-10 glasses weekly.