Physical
Medical
Family Medical History
Religion
Updates to ProfilePhysical
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Height:
6'4"
(193 cm) |
Weight:
203 lb
(92 kg) |
Eye Color:
Blue
|
Hair:
Blond/
Straight |
Skin Tone:
Light
|
Ancestry:
Caucasian
|
|
Blood Type:
A+
|
Ethnic Background:
Austrian-German-Irish/German
|
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Education:
MA/Public Administration
|
Occupation:
Military Officer
|
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Interests:
|
Camping, Guitar, Rock Climbing, Sailing, Swimming, Viola
|
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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 | 72 |
| 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 | 82 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Daughters
Your Daughter 1
| Question | Response |
| Current age or age at death | 1 |
| Living / Dead | Living |
Health Problems
Healthy
Your Mother's Father
| Question | Response |
| Current age or age at death | 87 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Fall in the shower, heart failure |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Other
No other diagnosed health problems at time of death
Your Mother's Mother
| Question | Response |
| Current age or age at death | 93 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Breast cancer |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Breast cancer
89
Declined treatment
Your Father's Father
| Question | Response |
| Current age or age at death | 28 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Died in a War |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Other
No diagnosed health problems at time of death
Your Father's Mother
| Question | Response |
| Current age or age at death | 69 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Heart attack |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Other
No other diagnosed health problems at time of death
Your Father's Sisters 1
| Question | Response |
| Current age or age at death | 80 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Pneumonia |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Other
No other diagnosed health problems at time of death
Your Father's Sisters 2
| 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 Father's Brothers 1
| Question | Response |
| Current age or age at death | 72 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Pneumonia |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Other
No other diagnosed health problems at time of death
Religion:
| Faith | Christian |
| Denomination | Catholic |
Updates to Profile
| Update Available | N/A |
| Updates - Personal | N/A |
| Updates - Medical | N/A |
| Updates - Family Medical History | N/A |