Summary Profile

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Donor Number: 4417

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:	Yes - Mother, age 33
Any dietary restrictions? If yes, explain:	No
Do you wear glasses or contact lenses? Are you near or far-sighted?	Yes - Near-sighted
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 History
See list of questions asked here

Your Mother

Question	Response	Comment/Age Affected
Current age or age at death	47
Health Problem	Arthritis in hands, no treatment	46
Health Problem	Alcohol abuse, treated through Alcoholics Anonymous, no longer an abuser	33
Living / Dead	Living

Your Father

Question	Response	Comment/Age Affected
Current age or age at death	41
Health Problem	Diabetes mellitus; No treatment required	39
Health Problem	High blood pressure; No treatment required	39
Living / Dead	Living

Brothers

Your Brother 1

Question	Response	Comment/Age Affected
Current age or age at death	22
Health Problem	Healthy
Living / Dead	Living

Sisters

Your Sister 1

Question	Response	Comment/Age Affected
Current age or age at death	17
Health Problem	Healthy (Half-sister)
Living / Dead	Living

Your Mother's Father

Question	Response	Comment/Age Affected
Current age or age at death	70
Health Problem	Healthy
Living / Dead	Living

Your Mother's Mother

Question	Response	Comment/Age Affected
Current age or age at death	72
Health Problem	Healthy
Living / Dead	Living

Your Mother's Sisters 1

Question	Response	Comment/Age Affected
Current age or age at death	49
Health Problem	Healthy
Living / Dead	Living

Your Father's Father

Question	Response	Comment/Age Affected
Current age or age at death	70
Health Problem	High blood pressure, treats with prescription medication	68
Living / Dead	Living

Your Father's Mother

Question	Response	Comment/Age Affected
Current age or age at death	70
Health Problem	Diabetes mellitus, treats with insulin	69
Living / Dead	Living

Your Father's Sisters 1

Question	Response	Comment/Age Affected
Current age or age at death	46
Health Problem	Healthy
Living / Dead	Living

Your Father's Brothers 1

Question	Response	Comment/Age Affected
Current age or age at death	39
Health Problem	Healthy
Living / Dead	Living

Religion:

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