Physical
Medical
Family Medical History
Religion
Updates to ProfilePhysical
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Height:
5'9"
(175 cm) |
Weight:
175 lb
(79 kg) |
Eye Color:
Brown
|
Hair:
Black/
Curly |
Skin Tone:
Medium Dark
|
Ancestry:
Caucasian
|
|
Blood Type:
O+
|
Ethnic Background:
Italian/Italian
|
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Education:
MS/Education
|
Occupation:
Teacher
|
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Interests:
|
Creating Artwork, Football, gymnastics, Nutrition, 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 | 60 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Your Father
| Question | Response |
| Current age or age at death | 66 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Brothers
Your Brother 1
| Question | Response |
| Current age or age at death | 30 |
| 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 | 40 |
| 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 | 78 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Heart failure. Heavy smoker. |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Heart failure
78
Sudden death. Heavy smoker. No treatment.
Your Mother's Mother
| Question | Response |
| Current age or age at death | 75 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Sudden death after husband passed away |
Health Problems
Healthy
Your Mother's Sisters 1
| 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 Sisters 2
| Question | Response |
| Current age or age at death | 66 |
| 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 | 76 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Prostate cancer |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Prostate Cancer
65
Chemotherapy and radiation
Prostate Cancer
76
Fatal
Your Father's Mother
| Question | Response |
| Current age or age at death | 86 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Failing health following severe fall |
Health Problems
Healthy
Your Father's Sisters 1
| Question | Response |
| Current age or age at death | 62 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Your Father's Sisters 2
| Question | Response |
| Current age or age at death | 56 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Your Father's Brothers 1
| Question | Response |
| Current age or age at death | 60 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Religion:
| Faith | Other |
| Denomination | Agnostic |
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. |