Medical form
PATIENT MEDICAL HISTORY
Name: Aqua
Age: 18 years
Sex: Female
Height: 5 ft 5 in/165 cm
Weight: 135 lbs/61.5 kg
[ X ] Magical by nature/practices magic.
[ ] Can't have magic used on.
[ ] Contagious (see notes).
Human
Average Lifespan: About 100
Rate of Maturity: About 18
Average age of Puberty: About 13
Normal Diet:
Human diet, see [here]
Common Ailments:
Normal human illnesses [here], magical drain
Specific Notes: (healing factors, special needs, etc)
Magic practitioner with healing spells (Cure and Esuna). Also has a weapon linked to her heart (spiritual sense) and can magically connect to another person's abilities and vice-versa. 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 ] Average | [ ] Low | [ ] 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 known.
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:
Trained in magic from very young age, so can self-heal with Cure spells and counter some magically-induced health problems (poisoning, blindness, etc.) with Esuna, though this is not an absolute cure. Magical drain recovers with time.
Have you recently been screened for species, sex, and age specific cancer risks?:
No.
Special notes on care: (Such as contagious diseases/conditions, special means of handling, special care taken in handling)
Record of Past Injuries:
Various cuts, bruises, and other injuries from battle, magically healed.
Ship Health Records:
Injured ankle, cut to back, concussion, and stolen magic/linker core (later restored). Other injuries healed via magic. SEXUAL HEALTH 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:
Reproductive Health (skip if N/A) Date of Last Menses/Estrus/Equiv (skip if n/a): [Here]
Number of pregnancies: 0
Number of pregnancies carried to term: 0
Age of first birth/hatching/etc. (if applicable): N/A
Total number of births/hatching/etc.: 0
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.
Normal Diet:
Human diet, see [here]
Common Ailments:
Normal human illnesses [here], magical drain
Specific Notes: (healing factors, special needs, etc)
Magic practitioner with healing spells (Cure and Esuna). Also has a weapon linked to her heart (spiritual sense) and can magically connect to another person's abilities and vice-versa. 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 ] Average | [ ] Low | [ ] 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 known.
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:
Trained in magic from very young age, so can self-heal with Cure spells and counter some magically-induced health problems (poisoning, blindness, etc.) with Esuna, though this is not an absolute cure. Magical drain recovers with time.
Have you recently been screened for species, sex, and age specific cancer risks?:
No.
Special notes on care: (Such as contagious diseases/conditions, special means of handling, special care taken in handling)
Record of Past Injuries:
Various cuts, bruises, and other injuries from battle, magically healed.
Ship Health Records:
Injured ankle, cut to back, concussion, and stolen magic/linker core (later restored). Other injuries healed via magic. SEXUAL HEALTH 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:
Reproductive Health (skip if N/A) Date of Last Menses/Estrus/Equiv (skip if n/a): [Here]
Number of pregnancies: 0
Number of pregnancies carried to term: 0
Age of first birth/hatching/etc. (if applicable): N/A
Total number of births/hatching/etc.: 0
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.