Physical
Medical
Family Medical History
Religion
Updates to ProfilePhysical
|
Height:
5'11"
(180 cm) |
Weight:
175 lb
(79 kg) |
Eye Color:
Hazel
|
Hair:
Brown/
Straight |
Skin Tone:
Light
|
Ancestry:
Caucasian
|
|
Blood Type:
A+
|
Ethnic Background:
Australian/English
|
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|
Education:
BS/Journalism
|
Occupation:
Writer and Editor
|
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Interests:
|
Family time, Team Sports, Writing
|
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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 | 71 |
| 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 | 74 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
High blood pressure
65
Lisinopril 20 mg daily
Seasonal Allergies
22
No treatment
Brothers
Your Brother 1
| Question | Response |
| Current age or age at death | 47 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Your Brother 2
| Question | Response |
| Current age or age at death | 36 |
| 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 | 49 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Your Sister 2
| 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
Sons
Your Son 1
| Question | Response |
| Current age or age at death | 4 |
| Living / Dead | Living |
Health Problems
Healthy
Daughters
Your Daughter 1
| Question | Response |
| Current age or age at death | 8 |
| Living / Dead | Living |
Health Problems
Healthy
Your Mother's Father
| Question | Response |
| Current age or age at death | 92 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Heart Attack |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Broken collar bone due to fall
84
No treatment
Heart Attack
92
None, fatal
Your Mother's Mother
| Question | Response |
| Current age or age at death | 90 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Heart attack |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Heart Attack
90
None, fatal
Your Mother's Sisters 1
| Question | Response |
| Current age or age at death | 69 |
| 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 | 5 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Seizures caused by birth trauma |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Nuchal cord birth injury
No treatment
Your Mother's Brothers 1
| Question | Response |
| Current age or age at death | 67 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Your Mother's Brothers 2
| Question | Response |
| Current age or age at death | 64 |
| 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 | 79 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Fall in apartment |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Idiopathic thrombocytopenic pupura
79
No treatment, diagnosed post mortem
Your Father's Mother
| Question | Response |
| Current age or age at death | 78 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Heart attack |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Breast cancer
68
Mastectomy
Breast cancer recurrence
78
No treatment
Your Father's Sisters 1
| Question | Response |
| Current age or age at death | 82 |
| 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 | 54 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Ovarian cancer |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Ovarian cancer
54
No treatment
Your Father's Brothers 1
| Question | Response |
| Current age or age at death | 67 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Religion:
| Faith | Christian |
| Denomination | Non-denominational |
Updates to Profile
| Update Available | N/A |
| Updates - Personal | N/A |
| Updates - Medical | N/A |
| Updates - Family Medical History | N/A |