Physical
Height:
5'10"
(177 cm) |
Weight:
214 lb
(97 kg) |
Eye Color:
Blue
|
Hair:
Brown/
Straight |
Skin Tone:
Medium Light
|
Ancestry:
Caucasian
|
Blood Type:
O+
|
Ethnic Background:
English/English-Portuguese
|
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Education:
AA/Marketing Sales
|
Occupation:
Army National Guard
|
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Interests:
|
Chess, Golf, Swimming, Woodworking
|
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 | 55 |
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 | 61 |
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 | 34 |
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 | 31 |
Living / Dead | Living |
Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Your Brother 3
Question | Response |
Current age or age at death | 29 |
Living / Dead | Living |
Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Your Brother 4
Question | Response |
Current age or age at death | 23 |
Living / Dead | Living |
Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Your Brother 5
Question | Response |
Current age or age at death | 19 |
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 | 25 |
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 | 20 |
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
Your Mother's Father
Question | Response |
Current age or age at death | 72 |
Living / Dead | Dead |
Cause of death and any treatment prior to death | Old age (specific cause unknown) |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Other
No known diagnosed health problems at time of death
Your Mother's Mother
Question | Response |
Current age or age at death | 84 |
Living / Dead | Dead |
Cause of death and any treatment prior to death | Old age (specific cause unknown) |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Other
No known diagnosed health problems at time of death
Your Mother's Sisters 1
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 Mother's Sisters 2
Question | Response |
Current age or age at death | 65 |
Living / Dead | Living |
Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Your Mother's Sisters 3
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
Healthy
Your Mother's Sisters 4
Question | Response |
Current age or age at death | 55 |
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 | 61 |
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 | 60 |
Living / Dead | Living |
Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Your Mother's Brothers 3
Question | Response |
Current age or age at death | 58 |
Living / Dead | Dead |
Cause of death and any treatment prior to death | Organ Failure |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Other
No other diagnosed health problems at time of death
Your Father's Father
Question | Response |
Current age or age at death | 68 |
Living / Dead | Dead |
Cause of death and any treatment prior to death | Unknown (no contact) |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Other
No known health problems at time of death (no contact)
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 | Breast Cancer |
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 | 65 |
Living / Dead | Dead |
Cause of death and any treatment prior to death | Unknown (no contact) |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Other
No known diagnosed health problems at time of death (no contact)
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 |