NAME: [surname, fore/middle]
BIRTHDATE: [d/m/y]
SPECIES: [insert here]
HEIGHT: [centimetres/feet]
WEIGHT: [kilogram/pounds]
EYE COLOR:
HAIR COLOR:
RACE/ETHNICITY:
HYPERTENSION:
SPOKEN LANGUAGES: [primary/secondary, or native/learned]
PREFERRED LANGUAGE: [probably ___ Basic or ___ Common]
NEXT OF KIN: [surname, forename ([relation], [age])]
EMERGENCY CONTACT: [surname, forename, relation, phone number (ala "07211 408555")]
LAST UPDATE: [d/m/y]

IMPORTANT INFORMATION

POSTMORTEM INSTRUCTIONS:
PROSTHETIC(S)/IMPLANTS(S): YES/NO - info if YES
ALLERGIES: YES/NO - info if YES

SURGICAL HISTORY:
Date [d/m/y] - Description - Surgeon - Location

OBSTETRIC HISTORY:
[surname, forename, gender, age]
If blank, put N/A

MEDICATION HISTORY:
[medication, dosage, every __ ([date] to [date])]

CURRENT MEDICATIONS/PRESCRIPTIONS:
[medication, dosage, every __]

Physical Evaluations:
[d/m/y] - [pass/fail] - [additional info]
[d/m/y] - [pass/fail] - [additional info]

DOCUMENTED PSYCHOLOGICAL DISORDERS:
[either list things here or put N/A]

Psychological Evaluations:
[d/m/y] - [pass/fail] - [additional info]
[d/m/y] - [pass/fail] - [additional info]

Medical Doctor's Notes:
[include a short IC note here, likely written by a doctor who has worked on or examined your character before]
-[Doctor [initial] [surname]]