OOC
Tabula Rasa Medical History
[OOC comments in brackets]
Name: William Bush
Gender: Male
Age, or approximate age of human body: 35
Length of time on island (in months): 13
Date and Place of Origin: the H.M.S. Renown, somewhere in the West Indies, 1802 [He would probably give more approximate lattitude and longitude, but I can't think of it right now]
Were you human before coming to TR: Of course.
Living Situation
Where on the island do you live? In a hut in the Hidden Hamlet
Number of roommates: 1
Do you live with children under the age of 18: No
General Health
Do you consider yourself healthy now: Yes.
What, if any, medications did you take regularly before coming to Tabula Rasa: None
Are you allergic to any medications: Not that he knows of.
Have you experienced any new health problems since arriving? If so, please describe: He broke his foot about nine months ago, but it healed fine.
When was your last tetanus shot? What?
Were you vaccinated for smallpox as a child? (If you were, you should have a small, round scar on your upper arm.) No.
What is your blood type, if known: Don't know.
Have you had any of the following:
Hepatitis
Measles
Meningitis
Mumps
Rheumatic fever
Rubella (German measles)
Scarlet fever
Smallpox
Whooping cough
Yellow fever
Chicken pox
Tuberculosis
Malaria
Typhoid
If you contracted other diseases before arriving, that are not on this list, please list them, and their symptoms:
To the best of your knowledge, have you ever been exposed to any of the following: No. [He's an eighteenth century sailor. Exposed to some of these? It's possible. Contracted? No. Telling any medical staff or even his mun? Also no.]
Herpes Simplex 1 (cold sores)
Herpes Simplex 2 (genital herpes)
Human Papilloma Virus
Cytomegalovirus (CMV)
Human Immunodeficiency Virus (HIV),
Gonorrhea
Chlamydia
Syphilis
Mononucleosis
Are there other health conditions that you want the clinic staff to know about?
For Those Who Can Bear Children
Are you currently pregnant (if so, when are you due):
Date of your last menstrual period if known:
List any previous -pregnancies, and the approximate date(s):
Do you have children, either on the island or not, if so, list their ages:
Have you miscarried, aborted a pregnancy, or had a still birth? If so, list date(s):
What birth control methods have you used in the past, and currently:
Family History
Do you have any blood relatives here, if yes, list names: None
Do any of the following run in your immediate family (mother, father, sisters, brothers):
Heart attack
Stroke
High blood pressure
Low blood pressure
Anemia (iron deficiency or other):
Cancer
Diabetes
Congenital heart defect
Don't know.
Lifestyle
Do you smoke: No.
Tobacco, or marijuana:
If yes, how often:
Do you drink alcohol? Yes
If yes, how much: Socially.
Do you drink caffinated beverages such as coffee or tea? Yes.
If yes, how much: Perhaps a cup or two of either a day.
Mental Health (If you answer yes to any of these, please list symptoms, dates and treatments.)
Have you experienced a serious head injury, either on the island or before: No.
Have you been treated for depression with medication or herbs: No.
Have you experienced manic episodes: A what?
Have you had unexplained mood swings: No.
Have you been diagnosed with serious mental illness, such as schizophrenia, multiple personality disorder, obsessive-compulsive disorder, or psychosis: No.