Cryogenic Laboratories, Inc.
Donor 1425 Summary Profile






Questions
Physical
Medical
Family Medical History
Updates to Profile

Physical
Race Cauc
Ethnic Background English/English-Welsh
Height 5'8''
Weight 149
Eye Color Green
Hair Brown/Straight
Skin Tone Light
Blood Type B+
Education BS/Nursing/
Occupation Registered Nurse
Interests Archery

Medical
QuestionResponse
Any dietary restrictions?
If yes, explain:		 N/A
Do you wear glasses or contact lenses?
Are you near or far-sighted?		 N/A
Allergies (medicines, food, pollens)?
If yes, please list substance and reaction caused:		 N/A
CMV IgG AntibodyNegative
CMV IgM AntibodyNegative
Note any comments regarding above items: N/A

Family Medical History

Your Mother
QuestionResponse
 Current age or age at death  N/A
 Health Problem
 N/A 
 Living / Dead N/A

Your Father
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 Current age or age at death  N/A
 Health Problem
 N/A 
 Living / Dead N/A

Brother(s)

Your Brother 1
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 Current age or age at death  N/A
 Health Problem
 N/A 
 Living / Dead N/A

Sister(s)

Your Sister 1
QuestionResponse
 Current age or age at death  N/A
 Health Problem
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 Living / Dead N/A

Your Sister 2
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 Current age or age at death  N/A
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Your Sister 3
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 Current age or age at death  N/A
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 Living / Dead N/A

Son(s)

Your Son 1
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 Current age or age at death  N/A
 Health Problem
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 Living / Dead N/A

Your Mother's Father
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 Current age or age at death  N/A
 Health Problem
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 Living / Dead N/A

Your Mother's Mother
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 Current age or age at death  N/A
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 Living / Dead N/A

Your Father's Father
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 Current age or age at death  N/A
 Health Problem
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 Living / Dead N/A

Your Father's Mother
QuestionResponse
 Current age or age at death  N/A
 Health Problem
 N/A 
 Living / Dead N/A

Updates to Profile
Update Available N/A
Updates - Personal N/A
Updates - Medical N/A
Updates - Family Medical History N/A