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Feb. 22nd, 2007 10:28 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
formerfratboyTabula Rasa Medical History
Name: Nick Stokes
Gender: Male
Age: 34
Length of time on island (in months): Entry: 1/21/07
Date and Place of Origin: May 2005, Las Vegas, Nevada
Were you human before coming to TR: Yes.
Living Situation
Where on the island do you live? Compound
Number of roommates: One (Greg Sanders)
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: None that I'm aware of.
Have you experienced any new health problems since arriving? If so, please describe: Complications resulting from arrival -- buried alive for 12 hours, dehydrated, attacked by fire ants, etc. Treated and released from clinic, now seeking mental health care from Dr. Deane.
When was your last tetanus shot? 2 years ago
Were you vaccinated for smallpox as a child? Yes.
What is your blood type, if known: A-
Have you had any of the following:
If you contracted other diseases before arriving, that are not on this list, please list them, and their symptoms: N/A
To the best of your knowledge, have you ever been exposed to any of the following:
Are there other health conditions that you want the clinic staff to know about? No.
For Those Who Can Bear Children -- Not applicable
Family History
Do you have any blood relatives here, if yes, list names: No, none.
Do any of the following run in your immediate family (mother, father, sisters, brothers):
Lifestyle
Do you smoke: No
Tobacco, or marijuana: N/A
If yes, how often: N/A
Do you drink alcohol? Yes
If yes, how much: Rarely -- just socially at home (2-3 beers, one or two times a month). Even more rarely here.
Do you drink caffinated beverages such as coffee or tea? Coffee
If yes, how much: Entirely too much to be healthy
Mental Health
Have you experienced a serious head injury, either on the island or before: Several concussions, generally treated and released.
Have you been treated for depression with medication or herbs: No
Have you experienced manic episodes: No
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: Not technically. Is currently working through some PTSD-like symptoms after the ordeal he went through in canon immediately prior to his entrance on the island.
Gender: Male
Age: 34
Length of time on island (in months): Entry: 1/21/07
Date and Place of Origin: May 2005, Las Vegas, Nevada
Were you human before coming to TR: Yes.
Living Situation
Where on the island do you live? Compound
Number of roommates: One (Greg Sanders)
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: None that I'm aware of.
Have you experienced any new health problems since arriving? If so, please describe: Complications resulting from arrival -- buried alive for 12 hours, dehydrated, attacked by fire ants, etc. Treated and released from clinic, now seeking mental health care from Dr. Deane.
When was your last tetanus shot? 2 years ago
Were you vaccinated for smallpox as a child? Yes.
What is your blood type, if known: A-
Have you had any of the following:
Hepatitis No
Measles No
Meningitis No
Mumps No
Rheumatic fever No
Rubella (German measles) No
Scarlet fever No
Smallpox No
Whooping cough No
Yellow fever No
Chicken pox Yes
Tuberculosis No
Malaria No
Typhoid No
If you contracted other diseases before arriving, that are not on this list, please list them, and their symptoms: N/A
To the best of your knowledge, have you ever been exposed to any of the following:
Herpes Simplex 1 (cold sores) No
Herpes Simplex 2 (genital herpes) No
Human Papilloma Virus No
Cytomegalovirus (CMV) No
Human Immunodeficiency Virus (HIV) No
Gonorrhea No
Chlamydia No
Syphilis No
Mononucleosis Yes, in college
Are there other health conditions that you want the clinic staff to know about? No.
For Those Who Can Bear Children -- Not applicable
Family History
Do you have any blood relatives here, if yes, list names: No, none.
Do any of the following run in your immediate family (mother, father, sisters, brothers):
Heart attack No
Stroke No
High blood pressure No
Low blood pressure No
Anemia (iron deficiency or other): No
Cancer No
Diabetes No
Congenital heart defect No
Lifestyle
Do you smoke: No
Tobacco, or marijuana: N/A
If yes, how often: N/A
Do you drink alcohol? Yes
If yes, how much: Rarely -- just socially at home (2-3 beers, one or two times a month). Even more rarely here.
Do you drink caffinated beverages such as coffee or tea? Coffee
If yes, how much: Entirely too much to be healthy
Mental Health
Have you experienced a serious head injury, either on the island or before: Several concussions, generally treated and released.
Have you been treated for depression with medication or herbs: No
Have you experienced manic episodes: No
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: Not technically. Is currently working through some PTSD-like symptoms after the ordeal he went through in canon immediately prior to his entrance on the island.
