Physical
Medical
Family Medical History
Religion
Updates to ProfilePhysical
|
Height:
182 cm
(6'0") |
Weight:
97 kg
(215 lb) |
Eye Color:
Hazel
|
Hair:
Brown/
Wavy |
Skin Tone:
Medium Dark
|
Ancestry:
Caucasian
|
|
Blood Type:
O+
|
Ethnic Background:
Italian/Polish
|
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|
Education:
MA/Educational Administration
|
Occupation:
Teacher
|
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|
Interests:
|
Coaching, Exercise
|
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Medical
| Question | Response |
| Have you or any of your family members been diagnosed with alcoholism or drug addiction? If yes, relation and age affected: | No |
| Any dietary restrictions? If yes, explain: | No |
| Do you wear glasses or contact lenses? Are you near or far-sighted? | No |
| Allergies (medicines, food, pollens)? If yes, please list substance and reaction caused: | No |
| CMV IgG Antibody | Positive |
| CMV IgM Antibody | Negative |
| Note any comments regarding above items: | N/A |
Family Medical HistorySee list of questions asked here
Your Mother
| Question | Response | Comment/Age Affected |
| Current age or age at death | 51 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Father
| Question | Response | Comment/Age Affected |
| Current age or age at death | 53 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Sisters
Your Sister 1
| Question | Response | Comment/Age Affected |
| Current age or age at death | 20 | |
| Health Problem | Hypothyroidism, treated with T4 supplement(Levothroid) | 14 |
| Living / Dead | Living |
Your Sister 2
| Question | Response | Comment/Age Affected |
| Current age or age at death | 19 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Sister 3
| Question | Response | Comment/Age Affected |
| Current age or age at death | 13 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Mother's Father
| Question | Response | Comment/Age Affected |
| Current age or age at death | 74 | |
| Health Problem | High blood pressure; treated with medication | 50 |
| Ulcer | 55 | |
| Stroke | 66 | |
| Alzheimer's Disease | 73 | |
| Living / Dead | Living |
Your Mother's Mother
| Question | Response | Comment/Age Affected |
| Current age or age at death | 73 | |
| Health Problem | Hypothyroidism, very mild case, no medication required. | 65 |
| Living / Dead | Living |
Your Mother's Sisters 1
| Question | Response | Comment/Age Affected |
| Current age or age at death | 48 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Mother's Brothers 1
| Question | Response | Comment/Age Affected |
| Current age or age at death | 52 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Mother's Brothers 2
| Question | Response | Comment/Age Affected |
| Current age or age at death | 50 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Father's Father
| Question | Response | Comment/Age Affected |
| Current age or age at death | 74 | |
| Health Problem | High blood pressure, treated through diet and exercise | 50 |
| Seizures, no occurrences for 10+ years | 62 | |
| Diabetes, treated with insulin | 65 | |
| Living / Dead | Living |
Your Father's Mother
| Question | Response | Comment/Age Affected |
| Current age or age at death | 73 | |
| Health Problem | Hyperthyroidism, very mild case, no medication required. | 45 |
| Living / Dead | Living |
Your Father's Sisters 1
| Question | Response | Comment/Age Affected |
| Current age or age at death | 50 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Father's Brothers 1
| Question | Response | Comment/Age Affected |
| Current age or age at death | 48 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Father's Brothers 2
| Question | Response | Comment/Age Affected |
| Current age or age at death | 46 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Religion:
| Faith | Christian |
| Denomination | Roman Catholic |
Updates to Profile
| Update Available | Yes |
| Updates - Personal | No change to donor Personal Profile: June 2008. |
| Updates - Medical | No change to donor Medical Profile: June 2008. |
| Updates - Family Medical History | No change to donor Family Medical History: June 2008. |