BASIC
Name:
Alias:
Date of Admission:
D.O.B:
Sex:
Martial Status:
Occupation:
Spouse:
Children:
HISTORY
Mode of Admission: (Voluntary, Certified, Transfer, Criminal?)
Mental State on Admission:
Predisposing: (Cause of admission)
Physical Condition:
Diagnosis:
EXTRA INFORMATION
This is where you can write a detailed description of your character and why they are here.
This is completely optional.