Medical Form: Atom
Sep. 16th, 2011 11:59 am![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png)
PATIENT MEDICAL HISTORY | ||||
Name: Tetsuwan Atom | Age: 12 years (physical appearance) | Sex: male | Height: 5'0"/152 cm | Weight: 90 lbs/41 kg |
[ ] Magical by nature/practices magic. | [ ] Can't have magic used on. | [ ] Contagious (see notes). | ||
ROBOT | ||||
Average Lifespan: N/A | Rate of Maturity: N/A | Average age of Puberty: N/A | ||
Normal Diet: N/A Common Ailments: N/A Specific Notes: Subject is a robot. |
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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. |
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Blood Pressure: [ ] Average | [ ] Low | [ ] High | ||||
Vision: [x] Fine | [ ] Near Sighted | [ ] Far Sighted | [x] Enhanced | ||||
If Enhanced, further explain: Subject is a robot with enhanced vision capable of scanning through solid objects and detecting distant and minute details well past human abilities. |
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Hearing: [ ] Deaf | [ ] Low | [ ] Average | [ ] High Range | [ ] Low Range | [x] Extremely Sensitive | ||||
If necessary, further explain: Subject claims to be able to hear "a thousand times better" than is human baseline. |
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Smell: [ ] Cannot Smell | [ ] Low | [ ] Average | [ ] High | [x] Extremely Sensitive | ||||
If Extremely Sensitive, further explain: ...okay this kid is a robot I'm just going to let him fill out the rest of the form seriously you guys |
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Known Allergies: N/A Are there any potential complications with healing processes we should be aware of when treating you?: I don't know if anyone out here would be able to repair me... on my Earth, the only one who could revive me was Dr. Tenma. But maybe someone could help fix my body if I get hurt or something? Do you have a healing factor different from the average for your species? If so, explain how here: I don't really heal like humans do. But I can be repaired. Have you recently been screened for species, sex, and age specific cancer risks?: I don't have any. Special notes on care: (Such as contagious diseases/conditions, special means of handling, special care taken in handling) Um, I don't really think doctors should be trying to treat me... Record of Past Injuries: [long and extensive list of robot battle injuries] Ship Health Records: None. |
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SEXUAL HEALTH | ||||
Have you ever been sexually active?: No. Are you currently Sexually Active: I'm just a kid! Have you recently been screened for STIs?: No Species specific sexually related health notes and/or issues: None |
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Reproductive Health (skip if N/A) | ||||
Date of Last Menses/Estrus/Equiv (skip if n/a): Number of pregnancies: wait what? Number of pregnancies carried to term: none! Age of first birth/hatching/etc. (if applicable): hatching?!! Total number of births/hatching/etc.: what kind of doctors are you?! |
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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: Boy, humans sure have a lot of problems... |