Physical
|
Height:
5'10"
(177 cm) |
Weight:
144 lb
(65 kg) |
Eye Color:
Brown
|
Hair:
Black/
Wavy |
Skin Tone:
Medium
|
Ancestry:
Latino
|
|
Blood Type:
O+
|
Ethnic Background:
Mexican-Spanish/Mexican
|
||||
|
Education:
BS/Physics
|
Occupation:
Student/Tutor, Restaurant Help
|
||||
|
Interests:
|
Cooking, Reading
|
||||
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 - Maternal grandfather, heavy drinker |
| 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 - Pollens: Cause sneezing |
| CMV IgG Antibody | Negative |
| 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 | 45 | |
| Health Problem | Anemia, in her early 30s, treated with iron supplements, no longer affected | |
| Living / Dead | Living |
Your Father
| Question | Response | Comment/Age Affected |
| Current age or age at death | 47 | |
| Health Problem | Deviated septum, since birth, treated with surgery at age 30 | |
| Kidney stones, in his 30s, passed naturally | ||
| Living / Dead | Living |
Brothers
Your Brother 1
| Question | Response | Comment/Age Affected |
| Current age or age at death | 30 | Maternal half brother |
| Health Problem | Healthy | |
| Living / Dead | Living |
Sisters
Your Sister 1
| Question | Response | Comment/Age Affected |
| Current age or age at death | 23 | |
| Health Problem | Healthy | |
| Mild seasonal allergies, since childhood, no treatment necessary | ||
| Living / Dead | Living |
Your Sister 2
| Question | Response | Comment/Age Affected |
| Current age or age at death | 21 | |
| Health Problem | Healthy | |
| Mild seasonal allergies, since childhood, no treatment necessary | ||
| Anxiety (situational), no treatment | 20 | |
| Living / Dead | Living |
Your Sister 3
| Question | Response | Comment/Age Affected |
| Current age or age at death | 8 | Paternal half sister |
| Health Problem | Healthy | |
| Mild seasonal allergies, no treatment necessary | ||
| Living / Dead | Living |
Your Mother's Father
| Question | Response | Comment/Age Affected |
| Current age or age at death | 78 | |
| Health Problem | Obese (not diagnosed), lifelong, no treatment | |
| Heavy drinker as an adult, no treatment | ||
| Liver damage, controlled by avoiding alcohol | 50 | |
| Living / Dead | Living |
Your Mother's Mother
| Question | Response | Comment/Age Affected |
| Current age or age at death | 75 | |
| Health Problem | Osteoarthritis, no treatment | 60 |
| Living / Dead | Living |
Your Mother's Sisters 1
| Question | Response | Comment/Age Affected |
| Current age or age at death | 47 | |
| Health Problem | Healthy | |
| Miscarriage (age unknown) | ||
| Living / Dead | Living |
Your Mother's Sisters 2
| Question | Response | Comment/Age Affected |
| Current age or age at death | 40 | |
| Health Problem | Multiple sclerosis, treated with physical therapy | 30 |
| Cause of death: Complications of multiple sclerosis | 40 | |
| Living / Dead | Dead |
Your Mother's Brothers 1
| 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 | 55 | |
| Health Problem | High blood pressure, no treatment | 40 |
| High cholesterol, no treatment | 40 | |
| Heart attack, fatal, no treatment | 55 | |
| Cause of death: Heart attack | 55 | |
| Living / Dead | Dead |
Your Father's Mother
| Question | Response | Comment/Age Affected |
| Current age or age at death | 82 | |
| Health Problem | Osteoarthritis, no treatment | 75 |
| Organ failure | 82 | |
| Cause of death: Organ failure | 82 | |
| Living / Dead | Dead |
Your Father's Sisters 1
| Question | Response | Comment/Age Affected |
| Current age or age at death | 59 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Father's Sisters 2
| Question | Response | Comment/Age Affected |
| Current age or age at death | 54 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Father's Sisters 3
| 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 | 63 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Father's Brothers 2
| Question | Response | Comment/Age Affected |
| Current age or age at death | 60 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Father's Brothers 3
| Question | Response | Comment/Age Affected |
| Current age or age at death | 49 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Religion:
| Faith | Other |
| Denomination | Agnostic |
Updates to Profile
| Update Available | N/A |
| Updates - Personal | N/A |
| Updates - Medical | N/A |
| Updates - Family Medical History | Update received March 2021: Maternal Grandmother has died at at 79 from COVID-19, treated with hospitalization. |

Physical
Medical
Family Medical History
Religion
Updates to Profile