Summary Profile

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Donor Number: 2766

Profile:

Family Medical History

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Physical

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:	Yes - Kosher
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	Negative
CMV IgM Antibody	Negative
Note any comments regarding above items:	N/A

Family Medical History
See list of questions asked here

Your Mother

Question	Response	Comment/Age Affected
Current age or age at death	58
Health Problem	Epilepsy, treated with medication	30
	Migraines, treated with medication	30
	Hypoglycemia, treated with diet regulation	40
	Benign ovarian cysts, removed with surgery	45
Living / Dead	Living

Your Father

Question	Response	Comment/Age Affected
Current age or age at death	62
Health Problem	Healthy
Living / Dead	Living

Brothers

Your Brother 1

Question	Response	Comment/Age Affected
Current age or age at death	28
Health Problem	Asthma, treated with inhaler	5
	Hay fever, treated with medication	5
	Methamphetamine abuse, no treatment	25
Living / Dead	Living

Your Mother's Father

Question	Response	Comment/Age Affected
Current age or age at death	41
Health Problem	Heart attack, no treatment	41
Health Problem	Cause of death: Heart attack	41
Living / Dead	Dead

Your Mother's Mother

Question	Response	Comment/Age Affected
Current age or age at death	86
Health Problem	Lung cancer (smoker), treated with chemotherapy and radiation	80
Health Problem	Cause of death: Lung cancer	86
Living / Dead	Dead

Your Mother's Sisters 1

Question	Response	Comment/Age Affected
Current age or age at death	55
Health Problem	Healthy
Living / Dead	Living

Your Mother's Sisters 2

Question	Response	Comment/Age Affected
Current age or age at death	53
Health Problem	Heart attack, no treatment	53
Health Problem	Cause of death: Heart attack	53
Living / Dead	Dead

Your Mother's Sisters 3

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	79
Health Problem	Heart attack, treated with bypass surgery	70
	Stroke, intensive care treatment	79
	Cause of death: Stroke	79
Living / Dead	Dead

Your Father's Mother

Question	Response	Comment/Age Affected
Current age or age at death	89
Health Problem	Stroke, no treatment	89
Health Problem	Cause of death: Stroke	89
Living / Dead	Dead

Your Father's Brothers 1

Question	Response	Comment/Age Affected
Current age or age at death	64
Health Problem	Healthy
Living / Dead	Living

Your Father's Brothers 2

Question	Response	Comment/Age Affected
Current age or age at death	56
Health Problem	Colon cancer, treated with surgery	55
Living / Dead	Living

Religion:

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