living_green: (Default)
2014-09-16 11:14 am

Asylum Entry Chart

small>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