Asylum Entry Chart
Sep. 16th, 2014 11:14 am![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
living_greensmall>No. ### (journal number)
Patient Admittance Form ### Asylum du Mal Idees
GIVEN NAME ### | Bridge Carson |
AGE AND SEX ### | 17, Male |
SPECIES ### | Human |
ORIGIN ### | Newtech City, Earth 2025 |
FAMILY ### | Mother (deceased), Father (deceased) |
OCCUPATION ### | D-Squad Cadet, SPD (Space Patrol Delta) Earth Defense Force |
FORM OF INSANITY ### | Haphephobia/Apotemnophobia |
SUPPOSED CAUSE ### | Psychometry Powers |
INDICATIVE FACTORS ### | Unwilling to have direct skin-to-skin contact with others, insists on clothes that cover all but his head, refuses to remove gloves |
DANGEROUS TO OTHERS ### | No |
DANGEROUS TO SELF ### | No |
DESTRUCTIVE TO PROPERTY ### | No |
STATE OF BODILY HEALTH ### | Good |
IDENTIFYING FEATURES (IF ANY) ### | None |
