Physical
Medical
Family Medical History
Religion
Updates to ProfilePhysical
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Height:
5'10"
(177 cm) |
Weight:
165 lb
(74 kg) |
Eye Color:
Green
|
Hair:
Brown/
Straight |
Skin Tone:
Light
|
Ancestry:
Caucasian
|
|
Blood Type:
B+
|
Ethnic Background:
Belarusian/Belarusian-Polish
|
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Education:
BS/Economics
|
Occupation:
Sales Associate
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Interests:
|
Boxing, Music, Reading, Soccer, Travel
|
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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 | Positive |
| 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 | 65 |
| 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 | 65 |
| 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 | 41 |
| 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 | 49 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Stroke, no treatment |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Other
No other health problems at time of death
Your Mother's Mother
| Question | Response |
| Current age or age at death | 85 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Natural Causes |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Other
No other health problems at time of death
Your Father's Father
| Question | Response |
| Current age or age at death | 71 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Natural Causes |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Other
No other health problems at time of death
Your Father's Mother
| Question | Response |
| Current age or age at death | 79 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Natural Causes |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Other
No other health problems at time of death
Your Father's Brothers 1
| 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
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 |