IMG

Mr. David Mctosh

Male, 35 years old
Married | Nigeria
Date of Birth: 01 Jan, 1989

Other details
Contact No.
Email ID
Education Level
Employement Status
+23 456 987 56
david.mc1@gmail.com
Post Grade
Business
Notes
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Residential Details

Residential
Details

Country
State
City
Town
Address
Nigeria
Lagos
Lagos
Ikeja
15 Awolowo Way, Ikeja, Lagos

Children Details

Children
Details

No. of Children
Child's Name
Child's Gender
Date of Birth
01
Lagos
Male
01 Jan, 2019

Next of Kin

NOK Relationship
Full Name
Gender
Contact
Email
Brother
Mr. Oblama Kim
Male
+23 963 852 741
oblama.87@gmail.com

Family Health History

Condition
Relationship
Other Info
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Brother
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Health Status & Lifestyle

Blood

Blood Type
Rh Factor
Genotype
Notes
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AB
Positive
SS
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Allergies

Type
Trigger
Notes
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Disability

Type
Impact
Devices Used
Notes
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Moderate
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Existing Medical Conditions

Condition
Cause if known
Medication/Treatment
Notes
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Mental Health

Type
Medication/Treatment
Notes
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Alcohol Consumption

Frequency
Quantity
Type of Alcohol
Notes
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Daily
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Beer
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Recreational Drug

Type of Substance
Frequency
Method of Use
State Issues Related to Use
History of Treatment or Rehabilitation
Notes
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Daily
Smoking
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Notes

Lorem ipsum is a placeholder text commonly used to demonstrate the visual form of a document or a typeface without relying on meaningful content. Lorem ipsum may be used as a placeholder before the final copy is available.