Summary Profile

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Donor Number: 4928

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 - Paternal grandfather, age 80 (not clinically diagnosed)
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:	Yes - Codeine: Causes rashes
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	59
Health Problem	Psoriasis, treated with medication	22
Living / Dead	Living

Your Father

Question	Response	Comment/Age Affected
Current age or age at death	60
Health Problem	Healthy
Living / Dead	Living

Your Mother's Father

Question	Response	Comment/Age Affected
Current age or age at death	68
Health Problem	Lung cancer, in his late 60s, no treatment
Health Problem	Cause of death: Lung cancer	68
Living / Dead	Dead

Your Mother's Mother

Question	Response	Comment/Age Affected
Current age or age at death	84
Health Problem	High blood pressure, treats with medication	68
	Strokes, two, in her 70s, treated with hospitalization and physical therapy	70
	Diabetes requiring insulin treatment (in her late 70s)	75
	Heart attack, no treatment	80
Living / Dead	Living

Your Mother's Brothers 1

Question	Response	Comment/Age Affected
Current age or age at death	62
Health Problem	High blood pressure, treated with diet modification	55
Living / Dead	Living

Your Mother's Brothers 2

Question	Response	Comment/Age Affected
Current age or age at death	58
Health Problem	High blood pressure, treated with diet modification	50
Living / Dead	Living

Your Father's Father

Question	Response	Comment/Age Affected
Current age or age at death	86
Health Problem	Heart attack, fatal, no treatment	86
Health Problem	Cause of death: Heart attack	86
Living / Dead	Dead

Your Father's Mother

Question	Response	Comment/Age Affected
Current age or age at death	90
Health Problem	Healthy
Living / Dead	Living

Your Father's Brothers 1

Question	Response	Comment/Age Affected
Current age or age at death	64
Health Problem	Type 2 Diabetes requiring insulin therapy	4
Living / Dead	Living

Your Father's Brothers 2

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

Religion:

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