Physical
Medical
Family Medical History
Religion
Updates to ProfilePhysical
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Height:
6'1"
(185 cm) |
Weight:
258 lb
(117 kg) |
Eye Color:
Brown
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Hair:
Brown/
Wavy |
Skin Tone:
Light
|
Ancestry:
Caucasian
|
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Blood Type:
A+
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Ethnic Background:
English-Irish-Nat. American-Scottish/Canadian-French-Polish-English
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Education:
BFA/Studio Art
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Occupation:
Software Support Analyst
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Interests:
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3D Art and Printing, Camping, Cocktail Mixology, Fishing, Kayaking, Technology
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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: | Yes - Sulfamethazole, skin reaction in the form of hives |
| 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 | 53 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Liver cancer |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Hepatitis B
45
Medication
Diabetes mellitus requiring insulin therapy
50
Insulin, blood sugar management
Other
Alcoholism, diagnosed at age 42, treated with rehab for 2 months and was sober 11 years prior to death
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
Your Mother's Father
| Question | Response |
| Current age or age at death | 63 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Heart Attack (fatal), no treatment |
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 | 82 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Organ failure due to old age, in a healthcare facility |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Osteoporosis
75
Medication
Your Mother's Brothers 1
| Question | Response |
| Current age or age at death | 73 |
| 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 | 68 |
| 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 | 65 |
| 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 | 61 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Lung cancer (smoker), no treatment |
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 | 88 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Organ failure due to old age, in a healthcare facility |
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 | 70 |
| 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 | 70 |
| 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 | 66 |
| 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 | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Religion:
| Faith | Other |
| Denomination | Spiritualism |
Updates to Profile
| Update Available | N/A |
| Updates - Personal | N/A |
| Updates - Medical | N/A |
| Updates - Family Medical History | N/A |