Template:Medical Record LCARS

{|style="max-width:700px"
 * style="background:teal;" width="100"|
 * width="600" colspan=2|Starfleet Medical.png

!width=180 align=right style="line-height: 130%;"| MEDICAL RECORD
 * Patient Reference Number:
 * Date of Birth:
 * Age:
 * Sex:
 * Species:
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 * style="background:teal; border-radius: 14px 0 0 0; border:0px solid #AFA3BF"|
 * colspan=2|
 * Height:
 * Weight:
 * Blood Type:
 * T/E Rating:
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 * colspan=2|
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 * colspan=2|

PAST MEDICAL HISTORY

 * Chronic Illnesses:
 * Medications:
 * Allergies and Reactions:
 * Sexual/Reproductive History:
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 * colspan=2|
 * colspan=2|

PAST SURGICAL HISTORY

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 * colspan=2|
 * colspan=2|

SUBSTANCE USE HISTORY

 * Alcohol:
 * Recreation Drugs:
 * Other:
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 * colspan=2|
 * colspan=2|

FAMILY MEDICAL HISTORY

 * Mother:
 * Father:
 * Siblings:
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 * colspan=2|
 * colspan=2|

SOCIAL HISTORY

 * Marital status:
 * Children:
 * Occupation/Assignment:
 * Diet:
 * Exercise:
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 * colspan=2|
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PHYSICIANS' NOTES

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 * colspan=2|

COUNSELORS' NOTES

 * }

Creates the Medical Record LCARS for Template:Medical Record.