Physical
Medical
Family Medical History
Religion
Updates to ProfilePhysical
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Height:
6'0"
(182 cm) |
Weight:
189 lb
(85 kg) |
Eye Color:
Brown
|
Hair:
Brown/
Wavy |
Skin Tone:
Medium
|
Ancestry:
Caucasian
|
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Blood Type:
O+
|
Ethnic Background:
German (Jewish)-Italian/Eastern European (Jewish)
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Education:
BA/Advertising
|
Occupation:
Student
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Interests:
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Working out
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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 |
| 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 HistorySee list of questions asked here
Your Mother
| Question | Response |
| Current age or age at death | 40 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Unknown |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Fell ill one week before death, possible viral infection
40
N/A
Your Father
| Question | Response |
| Current age or age at death | 50 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Sisters
Your Sister 1
| Question | Response |
| Current age or age at death | 22 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Your Mother's Father
| Question | Response |
| Current age or age at death | 60 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Lung cancer |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Lung cancer (smoker)
58
Chemotherapy
Your Mother's Mother
| Question | Response |
| Current age or age at death | 70 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Your Mother's Brothers 1
| Question | Response |
| Current age or age at death | 58 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Your Father's Father
| Question | Response |
| Current age or age at death | 70 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Leukemia
68
Chemotherapy
Your Father's Mother
| Question | Response |
| Current age or age at death | 68 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Amyotrophic Lateral Sclerosis (ALS)
65
At home palliative care
Your Father's Sisters 1
| Question | Response |
| Current age or age at death | 48 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Religion:
| Faith | None |
| Denomination | I'm half Jewish, half Catholic, but I am not religious |
Updates to Profile
| Update Available | Yes |
| Updates - Personal | No change to profile: November 2020 |
| Updates - Medical | No change to profile: November 2020 |
| Updates - Family Medical History | No change to profile: November 2020 |