Summary Profile

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Donor Number: 2712

Profile:

Family Medical History

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Physical

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
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 History
See list of questions asked here

Your Mother

Question	Response	Comment/Age Affected
Current age or age at death	57
Health Problem	Healthy
Living / Dead	Living

Your Father

Question	Response	Comment/Age Affected
Current age or age at death	52
Health Problem	High blood pressure	40
Health Problem	Herniated lumbar disc	49
Living / Dead	Living

Your Mother's Father

Question	Response	Comment/Age Affected
Current age or age at death	70
Health Problem	High blood pressure	55
Health Problem	Cause of death: Congestive heart failure	70
Living / Dead	Dead

Your Mother's Mother

Question	Response	Comment/Age Affected
Current age or age at death	57
Health Problem	Chronic bronchitis	48
	Lung cancer	54
	Cause of death: Lung cancer	57
Living / Dead	Dead

Your Father's Father

Question	Response	Comment/Age Affected
Current age or age at death	70
Health Problem	High blood pressure	44
	Arteriosclerosis	50
	Cause of death: Embolism	70
Living / Dead	Dead

Your Father's Mother

Question	Response	Comment/Age Affected
Current age or age at death	89
Health Problem	Shingles, treated with anti-viral drugs	77
Living / Dead	Living

Your Father's Sisters 1

Question	Response	Comment/Age Affected
Current age or age at death	60
Health Problem	Healthy
Living / Dead	Living

Religion:

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