med form
PATIENT MEDICAL HISTORY
Name: Homura Akemi
Age: 14 years
Sex: Female
Height: 154 cm
Weight: 107 lbs
[✓] Magical by nature/practices magic.
[ ] Can't have magic used on.
[ ] Contageous (see notes).
HUMAN
Average Lifespan: 60-80 yrs
Rate of Maturity: physically 14, mentally older
Average age of Puberty: 11-18 yrs
Normal Diet:
Mess hall food. See documentation on standard human dietary needs [here].
Common Ailments:
Colds, fevers, see file on [Common Human Illnesses].
Specific Notes:
n/a
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 | [ ] High
Vision: [ ] Fine | [ ] Near Sighted | [ ] Far Sighted | [✓] Enhanced
If Enhanced, further explain:
Used to be near-sighted; vision modified with magic.
Hearing: [ ] Deaf | [ ] 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:
Are there any potential complications with healing processes we should be aware of when treating you?:
No, it's fine.
Do you have a healing factor different from the average for your species? If so, explain how here:
Soul separated from body; soul contained in a Soul Gem which is on a ring.
Have you recently been screened for species, sex, and age specific cancer risks?:
No.
Special notes on care:
Do not separate from ring; will die if moved too far away from it.
Record of Past Injuries:
N/A; all injuries were healed with magic, leaving no trace.
Ship Health Records:
N/A
SEXUAL HEALTH
Date of Last Menses/Estrus/Equiv (skip if n/a):At home.
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:
N/A
DRUGS AND MEDICATION
Are you or should you be on any prescribed medication? If so, list below:
N/A
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