Patient Medical History

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PATIENT MEDICAL HISTORY
Name: Miranda Lotto	Age: 26 years	Sex: Female	Height: 5'6inch/168cm	Weight: 115lbs/52kg
[ ] Magical by nature/practices magic.	[ ] Can't have magic used on.		[ ] Contageous (see notes).
HUMAN
Average Lifespan: 45 years	Rate of Maturity: 21 years		Average age of Puberty: 15 years
Normal Diet: Standard human dietary needs. Find full documentation [here]. Common Ailments: Colds, fevers, poxes. See file on [Common Human Illnesses]. Specific Notes: NA
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: [ ] Average | [ ] Low | [X] High
Vision: [X] Fine | [ ] Near Sighted | [ ] Far Sighted | [ ] Enhanced
If Enhanced, further explain:
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?: 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?: No. Special notes on care: None. Record of Past Injuries: History of depression and high stress levels. Patient has also been stabbed in both hands in the past. Significant scarring on both the palm and back of hand. Ship Health Records: Patient is underweight and in low health. Continued check-ups required.
SEXUAL HEALTH
Date of Last Menses/Estrus/Equiv (skip if n/a): Three months prior. Have you ever been sexually active?: No. Are you currently Sexually Active: No. Have you recently been screened for STIs?: No. Species specific sexually related health notes and/or issues: NA.
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: Alcohol. Consumed regularly, at times to significant levels. Do you currently take any recreational or non-prescribed drugs or substances? Is so, please list them and their frequency of use below: No.