Physical
Medical
Family Medical History
Religion
Updates to ProfilePhysical
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Height:
6'6"
(198 cm) |
Weight:
284 lb
(128 kg) |
Eye Color:
Hazel
|
Hair:
Blond/
Straight |
Skin Tone:
Light
|
Ancestry:
Caucasian
|
|
Blood Type:
B+
|
Ethnic Background:
German-Polish/German-Polish
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Education:
AAS/Applied Electronics
|
Occupation:
Field Service Engineer
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Interests:
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Basketball, Bowling, Electronics, Metalworking, Outdoor Activities, Woodworking
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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? | Yes - Far-sighted, -2.25 both eyes |
| 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 | 56 |
| 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 | 57 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Diabetes mellitus not requiring insulin therapy
50
Metformin
Sisters
Your Sister 1
| Question | Response |
| Current age or age at death | 34 |
| 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 | 1 |
| Living / Dead | Living |
Health Problems
Healthy
Daughters
Your Daughter 1
| Question | Response |
| Current age or age at death | 0 |
| Living / Dead | Living |
Health Problems
Healthy
Your Mother's Father
| Question | Response |
| Current age or age at death | 86 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Heart failure, no treatment |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Diabetes mellitus requiring insulin therapy
76
Insulin
Other
Had cataract surgery at age 80
Your Mother's Mother
| Question | Response |
| Current age or age at death | 92 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Other
Cataracts at age 89, treated with eye drops
Your Mother's Sisters 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
Your Mother's Brothers 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 Father
| Question | Response |
| Current age or age at death | 56 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Suicide |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Bipolar (manic depressive psychosis)
56
Medication
Suicide or suicide attempts
56
Medication for bipolar disorder was frequently changed
Your Father'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 Father's Sisters 1
| Question | Response |
| Current age or age at death | 30 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Drug overdose |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Suicide or suicide attempts
30
None, drug overdose
Drug abuse, misuse, or addiction
30
None
Early death (less than age 50)
30
Drug overdose
Religion:
| Faith | None |
| Denomination | N/A |
Updates to Profile
| Update Available | N/A |
| Updates - Personal | N/A |
| Updates - Medical | N/A |
| Updates - Family Medical History | N/A |