Physical
Height:
5'7"
(170 cm) |
Weight:
153 lb
(69 kg) |
Eye Color:
Brown
|
Hair:
Black/
Straight |
Skin Tone:
Medium
|
Ancestry:
Latino
|
Blood Type:
O+
|
Ethnic Background:
Mexican/Mexican
|
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Education:
BS/Biological Sciences
|
Occupation:
Park Ranger
|
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Interests:
|
Exercise, Music, Outdoor Recreation, Travel
|
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 - Near-sighted, 20/450 |
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 | 50 |
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 | 55 |
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 | 28 |
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 | 18 |
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 | 80 |
Living / Dead | Dead |
Cause of death and any treatment prior to death | Heart failure, passed in sleep |
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 | 96 |
Living / Dead | Dead |
Cause of death and any treatment prior to death | Heart failure, passed in sleep |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Other
No other diagnosed health problems at time of death
Your Mother's Sisters 1
Question | Response |
Current age or age at death | 66 |
Living / Dead | Dead |
Cause of death and any treatment prior to death | Stomach Cancer, Chemotherapy |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Stomach Cancer
60
Chemotherapy
Your Mother's Sisters 2
Question | Response |
Current age or age at death | 58 |
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 | 46 |
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 | 69 |
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 | 67 |
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 | 55 |
Living / Dead | Living |
Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Your Mother's Brothers 4
Question | Response |
Current age or age at death | 53 |
Living / Dead | Living |
Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Your Mother's Brothers 5
Question | Response |
Current age or age at death | 52 |
Living / Dead | Living |
Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Your Mother's Brothers 6
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
Disease
Age Diagnosed
Treatment For Condition
Any cancer not mentioned above
46
Mouth Cancer, Chemotherapy (Smoker)
Your Mother's Brothers 7
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 Mother's Brothers 8
Question | Response |
Current age or age at death | 35 |
Living / Dead | Dead |
Cause of death and any treatment prior to death | Gunshot wound, no treatment |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Early death (less than age 50)
35
Gunshot wound, no other diagnosed health problems at time of death
Your Father's Father
Question | Response |
Current age or age at death | 80 |
Living / Dead | Dead |
Cause of death and any treatment prior to death | Heart failure, passed in sleep |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Other
No other diagnosed health problems at time of death
Your Father's Mother
Question | Response |
Current age or age at death | 97 |
Living / Dead | Dead |
Cause of death and any treatment prior to death | Heart failure, passed in sleep |
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 | 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 | 59 |
Living / Dead | Living |
Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Your Father's Sisters 3
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 | 75 |
Living / Dead | Dead |
Cause of death and any treatment prior to death | Heart failure, passed in sleep |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Other
No other diagnosed health problems at time of death
Your Father's Brothers 2
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's Brothers 3
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 Brothers 4
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 5
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 Brothers 6
Question | Response |
Current age or age at death | 58 |
Living / Dead | Living |
Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Your Father's Brothers 7
Question | Response |
Current age or age at death | 54 |
Living / Dead | Living |
Cause of death and any treatment prior to death | N/A |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Prostate cancer
53
Chemotherapy and Radiation
Your Father's Brothers 8
Question | Response |
Current age or age at death | 46 |
Living / Dead | Dead |
Cause of death and any treatment prior to death | Alcohol Poisoning, no treatment |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Drug abuse, misuse, or addiction
46
No treatment
Early death (less than age 50)
46
Alcohol Poisoning
Your Father's Brothers 9
Question | Response |
Current age or age at death | 44 |
Living / Dead | Living |
Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
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 |