Summary Profile

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Donor Number: 5151

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:	No - But I choose to eat mostly organic foods
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	60
Health Problem	High blood pressure, controlled with medication and exercise	55
Health Problem	High cholesterol, controlled with medication and exercise	55
Living / Dead	Living

Your Father

Question	Response	Comment/Age Affected
Current age or age at death	59
Health Problem	Healthy
Living / Dead	Living

Sisters

Your Sister 1

Question	Response	Comment/Age Affected
Current age or age at death	30
Health Problem	Asthma, for about one year, used an inhaler when needed	9
Health Problem	Kidney stone, passed normally	13
Living / Dead	Living

Your Sister 2

Question	Response	Comment/Age Affected
Current age or age at death	26
Health Problem	Healthy
Living / Dead	Living

Your Mother's Father

Question	Response	Comment/Age Affected
Current age or age at death	76
Health Problem	Emphysema, managed with oxygen (heavy smoker)	74
	Alzheimer's, managed with medication	75
	Lung cancer, treated with chemotherapy	75
	Cause of death: Lung cancer	76
Living / Dead	Dead

Your Mother's Mother

Question	Response	Comment/Age Affected
Current age or age at death	81
Health Problem	Bronchitis, hospitalized, treated with medication	78
	Chronic obstructive pulmonary disease (COPD), treated with medication (heavy smoker)	80
	Cause of death: COPD	81
Living / Dead	Dead

Your Mother's Brothers 1

Question	Response	Comment/Age Affected
Current age or age at death	67
Health Problem	Healthy
Living / Dead	Living

Your Father's Father

Question	Response	Comment/Age Affected
Current age or age at death	81
Health Problem	Alzheimer's, managed with medication	79
	Heart attack, no treatment	80
	Stroke, no treatment	81
	Cause of death: Stroke	81
Living / Dead	Dead

Your Father's Mother

Question	Response	Comment/Age Affected
Current age or age at death	83
Health Problem	Osteoporosis, treated with calcium supplements	75
	Stomach cancer, treated with chemotherapy	81
	Cause of death: Stomach cancer	83
Living / Dead	Dead

Your Father's Sisters 1

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

Religion:

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